Retrospective Analysis of Healthcare Resource Use, Treatment Patterns, and Treatment-related Events in Patients with Huntington's Disease-associated Chorea Initiated on Tetrabenazine

Victor W Sung; Ravi G Iyer; Sanjay K Gandhi; Victor Abler; Brian Davis; Debra E Irwin; Karen E Anderson

doi:10.36469/9779

Retrospective Analysis of Healthcare Resource Use, Treatment Patterns, and Treatment-related Events in Patients with Huntington's Disease-associated Chorea Initiated on Tetrabenazine

J Health Econ Outcomes Res. 2018 Jan 8;6(1):15-24. doi: 10.36469/9779. eCollection 2018.

Authors

Victor W Sung¹, Ravi G Iyer², Sanjay K Gandhi², Victor Abler², Brian Davis³, Debra E Irwin⁴, Karen E Anderson⁵

Affiliations

¹ University of Alabama at Birmingham, Department of Neurology, Division of Movement Disorders, Birmingham, AL.
² Teva Pharmaceutical Industries, Frazer, PA.
³ Truven Health Analytics, an IBM Company, Cambridge, MA.
⁴ Truven Health Analytics, an IBM Company, Durham, NC.
⁵ Georgetown University, Washington, DC.

PMID: 32685569
PMCID: PMC7309957
DOI: 10.36469/9779

Abstract

Background: Huntington's disease (HD) is a multifaceted neurodegenerative disorder characterized by involuntary movements, specifically chorea, as well as behavioral and psychiatric disturbance, and cognitive dysfunction. Tetrabenazine was the first approved treatment for chorea, although tolerability concerns exist.

Objectives: To characterize demographic and clinical characteristics of HD patients with chorea based on tetrabenazine use and examine treatment persistence with tetrabenazine in a real-world setting.

Methods: Patients with a claim for HD-associated chorea (ICD-9-CM code 333.4) between 1/1/08 and 9/30/15 were selected from the MarketScan^® Commercial and Medicare Supplemental databases. The first diagnosis date during the study period was considered the index date, with ≥6 months of continuous medical and prescription coverage before and after the index date. Treatment persistence was defined as the number of days from initiation to discontinuation or end of follow-up period. Discontinuation was defined as a gap in therapy of ≥60 days.

Results: 1644 patients met selection criteria (mean age ± standard deviation: 54.5 ± 15.5), of which 151 (9.2%) were treated with tetrabenazine during the study period. The average (median) daily dose of tetrabenazine during the treatment period was 45.5 (42.3) mg/day. A total of 41.8% (59/141) of HD patients who initiated tetrabenazine experienced a ≥60-day gap in tetrabenazine therapy, with a median time to discontinuation of 293.5 days. During the 6-month post-index period after HD diagnosis, HD patients incurred higher all-cause healthcare costs ($20 204) vs the 6-month pre-index period ($6057), driven by higher hospitalization and pharmacy costs.

Conclusions: A small percentage of HD patients with chorea were treated with tetrabenazine and discontinuation rates were high among those receiving treatment, with a median time to discontinuation of 9 months.

Keywords: Huntington’s disease; chorea; healthcare resource; retrospective study; tetrabenazine; treatment-related events.