Objective: To determine if there are differences in treatment patterns and outcomes in US patients, who often must pay for some of their care, and Non-US patients, who tend to have care that is covered by  a national health insurance.

Background: The Parkinson’s Foundation Outcomes Project (PoP) is an international, longitudinal cohort of Parkinson’s disease (PD) patients that collects data regarding treatment and outcomes.  This data set was used for this study.

Method: US and Non-US patients were compared with respect to: (a) case-mix based on demographic variables; (b) treatment patterns; and (c) outcomes based on annual changes in mobility (measured by timed up and go (TUG)), health related quality of life (measured by the PDQ-39), and utilization of health care events or problems associated with PD (measured by number of emergency  department (ED) visits and hospital stays). Differences were evaluated using parametric and non-parametric statistics for continuous variables and chi-squared values for categorical variables.

Results: After excluding patients with diagnostic certainty less than 90%, there were 7898 US patients and 2818 Non-US patients.  US patients were earlier into their disease (7.0 vs 8.0 yrs), less likely to be in H&Y stages 3-5 (31.3% vs 36.7%), had fewer comorbidities (1.0 vs 1.7), but were more likely to report 1 or more falls (35.5% vs 32.2%). US patients were more likely to be treated with DBS (18.0% vs 11.4%), PT (44.4% vs 37.0%), or OT (15.8% vs 11.9%). In contrast, US patients were similar in receiving services from psychologists (2.6% vs. 2.3%), psychiatrists (3.8% vs 4.9%), dieticians (1.4% vs 3.3%), and SLP (9.0% vs 8.6%). The results suggest that US patients had (a) similar annual deterioration in quality of life, (PDQ-39 scores worsened 1.6 points per year in US vs 1.8 points in Non-US patients); (b) similar annual decrease in mobility (TUG scores worsened by 0.9 seconds per year in US vs 0.9 seconds in Non-US patients), and (c) similar rates of increase in utilization of EDs and hospital stays (0.07 increase per year in US vs 0.06 increase in Non-US patients).

Conclusion: The results suggest that US PD patients tended to visit CoEs earlier post diagnosis of PD. US patients tended to more frequently utilize some therapies (e.g., DBS, PT and OT).  Despite these differences, US and non-US patients appeared to have similar annual changes in quality of life, mobility and utilization of EDs and hospital admissions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-treatments-and-outcomes-us-v-non-us-patients/