Song Yan, E Jian-Yu, Guo Tracy, Sasane Rahul, Arcona Steve, Keshava Nirmal, Wu Eric
Analysis Group, Inc, Boston, MA, USA.
Cerevel Therapeutics, Cambridge, MA, USA.
Clinicoecon Outcomes Res. 2023 Aug 2;15:631-643. doi: 10.2147/CEOR.S422023. eCollection 2023.
Studies on real-world treatment patterns and long-term economic burden of Parkinson's disease (PD) have been limited.
To assess treatment patterns, healthcare resource utilization (HRU), and costs associated with PD symptoms and treatment-related adverse events (AEs) among Medicare beneficiaries in the United States.
A 100% Medicare Fee-For-Service data (2006-2020) of patients with PD were analyzed. PD treatment patterns were described for the subset of patients who had no previously observed PD treatments or diagnoses (ie, the incident cohort). HRU and healthcare costs associated with PD symptoms were assessed for all patients with PD (ie, the overall cohort) and that associated with treatment-related AEs were assessed for the subset of patients who received PD treatments after PD diagnosis (ie, the active treatment cohort), using longitudinal models with repeated measures.
Overall, 318,582 patients were included (mean age at PD diagnosis: 77.4 years; 53.3% female). Among patients in the incident cohort (N=214,829), 51.1% initiated levodopa monotherapy and 5.9% initiated dopamine agonists (DAs) monotherapy as first-line treatment. The proportion of incident patients treated with DAs and other PD therapies generally increased from post-diagnosis years 1 to 10. The median time from diagnosis to PD treatment initiation was 2.0 months; the median time to treatment discontinuation was the longest with levodopa (18.7 months), followed by DAs (9.5 months). In the overall cohort, PD symptoms, especially motor symptoms and severe motor symptoms, were associated with significantly higher rates of HRU and costs. In the active treatment cohort (N=234,298), treatment-related AEs were associated with significantly higher rates of HRU and medical costs.
While levodopa is still the mainstay of PD management, considerable heterogeneity exists in real-world treatment patterns. Overall, PD symptoms and AEs were associated with significantly higher HRU and healthcare costs, suggesting unmet medical needs for PD treatments with better tolerability profiles.
关于帕金森病（PD）真实世界治疗模式和长期经济负担的研究有限。
评估美国医疗保险受益人中与PD症状及治疗相关不良事件（AE）相关的治疗模式、医疗资源利用（HRU）和成本。
分析了100%的PD患者医疗保险按服务付费数据（2006 - 2020年）。对之前未观察到PD治疗或诊断的患者子集（即发病队列）描述了PD治疗模式。使用重复测量的纵向模型，对所有PD患者（即总体队列）评估与PD症状相关的HRU和医疗成本，对PD诊断后接受PD治疗的患者子集（即积极治疗队列）评估与治疗相关AE相关的HRU和医疗成本。
总体而言，纳入了318,582例患者（PD诊断时的平均年龄：77.4岁；53.3%为女性）。在发病队列患者（N = 214,829）中，51.1%开始左旋多巴单药治疗，5.9%开始多巴胺激动剂（DAs）单药治疗作为一线治疗。从诊断后第1年到第10年，接受DAs和其他PD治疗的发病患者比例总体上有所增加。从诊断到开始PD治疗的中位时间为2.0个月；治疗停药的中位时间以左旋多巴最长（18.7个月），其次是DAs（9.5个月）。在总体队列中，PD症状，尤其是运动症状和严重运动症状，与显著更高的HRU率和成本相关。在积极治疗队列（N = 234,298）中，治疗相关AE与显著更高的HRU率和医疗成本相关。
虽然左旋多巴仍然是PD管理的主要药物，但真实世界的治疗模式存在相当大的异质性。总体而言，PD症状和AE与显著更高的HRU和医疗成本相关，这表明对具有更好耐受性的PD治疗存在未满足的医疗需求。
