Researchers Identify Common Treatment Patterns for Patients With Parkinson Disease

In a study by Richard Houghton from Product Development Personalized Health Care and  colleagues investigated the treatment patterns found in patients with Parkinson disease (PD). Data was obtained from insurance claims to determine patients’ treatment and find patterns. One aspect they were especially interested in was the timing of treatment in relation to the timing of a patient’s initial diagnosis. They also studied how treatment patterns differed among patients due to age, gender, and level of comorbidity.

In this study, Mr Houghton and his team used extracted data from Truven Health MarketScan Commercial Claims and Medicare Supplemental databases. They also specifically used newly diagnosed patients and identified patients using International Classification of Disease (ICD) codes. Patients were followed from the first day of their diagnosis. They also used the Charlson Comorbidities and the Charlson Comorbidity Index (CCI) to account for burden of disease and other comorbidities. Then, they analyzed the patients’ demographics and comorbidities. Patients that discontinued treatment before 180 days, were removed from this analysis. Some of the reasons for discontinuation were patient age at diagnosis, gender and their CCI score.

 The study was conducted based on data from January 1, 2008, to December 31, 2016.

Results revealed that out of the 84,104 patients of 209,046 patients from the data set were eligible for this analysis. About half (58.3%) of patients were male and 81.5% of patients had insurance coverage. Only 3.0% of patients with PD were under the age of 50. Additionally, 64.7% of patients had one or more comorbid conditions, the most prevalent conditions being diabetes, cerebrovascular disease, and congestive heart disease. The most common treatment used was found to be levodopa or combination therapy, the second was dopamine agonists. They also noticed a pattern in initiation of individual treatment being delayed in female patients with a higher comorbidity burden. 39.1% of patients also switched treatments during a follow-up appointment. Most patients that switched added levodopa into their treatment and as a patient’s age increased in this study, the researchers observed that they had a lower likelihood of switching their treatment. Patients that were diagnosed by a non-neurologist were also less likely to switch treatments.

“The major limitation of this study surrounds the unknown accuracy of identifying truly incident PD patients and the specific timing of diagnosis via insurance claims. Claims data are collected for billing purposes, so despite careful study design the diagnostic information retrieved does not necessarily reflect the first or final diagnoses for all patients,” the authors wrote.

This suggests that PD diagnosis claims are closely linked to PD treatment claims. The most prescribed therapies were levodopa and a combination of levodopa and another treatment. However, a patient’s age and comorbidity burden influence the treatment that is prescribed and when a patient is administered medication.

Reference:

Houghton R, Boess F, Verselis L, et al. Treatment patterns in patients with incident Parkinson's disease in the United States. J Parkinsons Dis. 2019;9(4):749-759. doi: 10.3233/JPD-191636