Aims: Within 5 years of initiating carbidopa/levodopa, ∼50% of patients with Parkinson's disease (PD) experience "OFF" episodes; little is known about the cost burden. We investigated the association of "OFF" episodes with patient characteristics, healthcare resource utilization (HCRU), and healthcare costs.
Methods: Analyses used neurologist-provided data from the US-specific 2017 and 2019 Adelphi Real World Disease Specific Programme for PD, including duration of "OFF" episodes and HCRU for 10-12 consecutive patients. Patients were grouped by presence/absence of "OFF" episodes and by average hours of daily "OFF" time. Between-group differences were assessed for demographics, personal circumstances, and clinical characteristics. Regression analyses modeled the relationship of "OFF" episodes with HCRU and costs.
Results: Of 1,309 patients, 41% experienced "OFF" episodes, 25% of whom were "OFF" ≥4 h/day. Patients having "OFF" episodes had more severe PD, were diagnosed for longer, and were younger than those without "OFF" (p < .0001). "OFF" episodes were associated with a greater number of prescribed PD drugs (p < .0001). Patients without "OFF" episodes were more likely to have full-time employment and less likely to be retired or unemployed because of PD (p < .001). Patients with and without "OFF" episodes had different living situations (p < .001): patients experiencing "OFF" were less likely to live alone and more likely to live in a nursing home and have a professional caregiver (p < .001). In the past 12 months, the number of hospitalizations, intensive care admissions, and emergency room visits; nights hospitalized; costs of consultations and hospitalizations; and total direct costs were all higher for patients experiencing "OFF" episodes (p < .05).
Conclusion: Patients with PD and "OFF" episodes had higher HCRU and costs than those without "OFF," suggesting that "OFF" episodes contribute to the economic burden of PD. Further research is warranted to examine the extent that current PD treatments and treatment patterns impact HCRU and costs.
Keywords: I10; I11; Parkinson’s disease; cost; healthcare resource utilization; motor fluctuations; real-world; “OFF” episodes.