Rajagopalan Krithika, Rashid Nazia, Yakkala Vinod, Doshi Dilesh
Anlitiks Inc., Windermere, FL, USA.
Medical Affairs, Acadia Pharmaceuticals Inc., San Diego, CA, USA.
Clinicoecon Outcomes Res. 2024 Mar 11;16:149-159. doi: 10.2147/CEOR.S452162. eCollection 2024.
Patients with Parkinson's disease psychosis (PDP) treated with pimavanserin (PIM) versus other atypical antipsychotics (AAPs) including quetiapine (QUE) may have health-care cost savings due to fewer skilled nursing facility-stays (SNF-stays) and long-term care admissions (LTCA).
A decision analytic model was developed using the 2019 Medicare Patient Driven Payment Model (PDPM) to estimate SNF-stays and LTCA associated per-patient- per-year (PPPY) facility and rehabilitation costs among patients that initiated PIM vs QUE or vs other-AAPs (i.e, quetiapine, risperidone, olanzapine, aripiprazole). Model inputs were derived for: (i) annual SNF-stay and LTCA rates from an analysis of Medicare beneficiaries with PDP, and (ii) annual mean rehabilitation and resident care-stay costs from PDPM case-mix adjusted value-based payment rates for 5 rehabilitation components (ie, physical-therapy, occupational-therapy, nursing, speech-language pathology, non-therapy ancillary), and an additional variable-per-diem for room/board services. PPPY costs were estimated from (i) SNF-stay and (ii) LTCA rates multiplied by annual mean costs of stay in 2022 USD. Probabilistic sensitivity analysis (PSA) was performed using 1000 Monte Carlo simulations.
Overall SNF-stay rates of 20.2%, 31.4%, and 31.7%, and LTCA rates of 23.2%, 33.8%, 34.6% were observed for PIM, QUE, and other-AAPs, respectively. Based on annual mean costs, PPPY SNF-stay rehabilitation and resident related costs for PIM ($41,808) vs QUE ($65,172) or vs other-AAPs ($65,664), resulted in $23,364 and $23,856 PPPY cost savings, respectively. Similarly, PPPY LTCA rehabilitation and resident related costs for PIM ($47,957) vs QUE ($70,091) or vs other-AAPs ($71,566) resulted in $22,134 and $23,609 PPPY cost-savings for PIM, respectively. PSA suggested PIM would provide cost-savings vs QUE or other-AAPs in >99% of iterations.
In this analysis, PIM demonstrated nearly 36% and 32% lower PPPY SNF-stays and LTCA costs, respectively, vs QUE or other-AAPs. Research examining additional cost-offsets (i.e., fewer falls/fractures) associated with SNF-stay or LTCA may be needed.
与包括喹硫平（QUE）在内的其他非典型抗精神病药物（AAPs）相比，接受匹莫范色林（PIM）治疗的帕金森病精神病（PDP）患者，由于较少入住专业护理机构（SNF）和长期护理住院（LTCA），可能节省医疗保健成本。
使用2019年医疗保险患者驱动支付模式（PDPM）开发了一个决策分析模型，以估计开始使用PIM与QUE或其他AAPs（即喹硫平、利培酮、奥氮平、阿立哌唑）的患者中，每位患者每年（PPPY）的SNF和LTCA相关的机构和康复成本。模型输入数据来源于：（i）对患有PDP的医疗保险受益人的分析得出的年度SNF住院率和LTCA率，以及（ii）根据PDPM病例组合调整后的基于价值的支付率得出的5个康复组成部分（即物理治疗、职业治疗、护理、言语病理学、非治疗辅助）的年度平均康复和住院护理成本，以及房间/膳食服务的额外每日变量成本。PPPY成本是根据（i）SNF住院率和（ii）LTCA率乘以2022年美元计算的年度平均住院成本估算得出的。使用1000次蒙特卡洛模拟进行概率敏感性分析（PSA）。
PIM、QUE和其他AAPs的总体SNF住院率分别为20.2%、31.4%和31.7%，LTCA率分别为23.2%、33.8%、34.6%。基于年度平均成本，PIM的PPPY SNF住院康复和住院相关成本（41,808美元）与QUE（65,172美元）或其他AAPs（65,664美元）相比，分别节省了23,364美元和23,856美元的PPPY成本。同样，PIM的PPPY LTCA康复和住院相关成本（47,957美元）与QUE（70,091美元）或其他AAPs（71,566美元）相比，分别为PIM节省了22,134美元和23,609美元的PPPY成本。PSA表明，在超过99%的迭代中，PIM与QUE或其他AAPs相比将节省成本。
在本分析中，与QUE或其他AAPs相比，PIM的PPPY SNF住院率和LTCA成本分别降低了近36%和32%。可能需要进行研究，以检查与SNF住院或LTCA相关的其他成本抵消因素（即更少的跌倒/骨折）。
