title: Early retirement and income loss in patients with early and advanced Parkinson's disease.
abstract: BACKGROUND
  The indirect costs of Parkinson's disease (PD) may be larger than direct healthcare costs, and the largest component of indirect costs is income loss related to early retirement. No recent retrospective analysis details PD-related early retirement and income loss in the US.
  
  
  OBJECTIVE
  We used an observational, matched cohort to study wages and labour force participation over 4 years and to simulate lifetime income losses conditional on being newly diagnosed with PD (naive) or having evidence of increasing disability.
  
  
  METHODS
  Actively employed primary beneficiaries of private insurance policies aged 18-64 years with more than two PD diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]: 332.x) or one diagnosis and a prescription of an antiparkinsonian drug were selected from a privately insured claims database. Continuous health coverage during analysis periods was required. Naive patients were defined as having no claims history indicative of PD during the year prior to first diagnosis or prescription use. A PD with ambulatory assistance devices (PDAAD) cohort was also followed from the date of first evidence of a wheelchair or walker. Controls without PD were matched on age, sex and region. Survival analysis and Wilcoxon rank sum tests were used to compare rates of early retirement and income loss. A simulation of projected economic loss was conducted for PD cohorts diagnosed at different ages using Bureau of Labor Statistics labour force participation and income data.
  
  
  RESULTS
  Naive PD patients (n = 278) and PDAAD patients (n = 28) were on average aged 53 years and had significantly higher rates of co-morbidities at baseline versus controls. Conditional on being employed, there was no statistical difference in earnings. However, the hazard of early retirement associated with PD was 2.08 (p < 0.001) for the naive cohort and 5.01 (p < 0.001) for the PDAAD cohort. From age 40 to 79 years, earnings losses in year 2009 values were $US569 393, $US188 590, $US35 496 and $US2451 for those diagnosed at age 45, 55, 65 and 75 years, respectively. Estimates increased by 9% to 37% when using expected 2018 labour force participation estimates.
  
  
  CONCLUSIONS
  The cost of early retirement associated with patients with PD was substantial. Given that the proportion of Americans participating in the labour force in older age groups is expected to increase, PD-related early retirement costs will likely rise.
authors.affiliation: Analysis Group, Inc., Boston, MA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Johnson
authors.forename: Matthew
authors.initials: M
authors.lastname: Davis
authors.forename: Anna
authors.initials: A
authors.lastname: Kaltenboeck
authors.forename: Howard
authors.initials: H
authors.lastname: Birnbaum
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Grubb
authors.forename: Marcy
authors.initials: M
authors.lastname: Tarrants
authors.forename: Andrew
authors.initials: A
authors.lastname: Siderowf
mesh_terms: D016022:Case-Control Studies; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000191:economics*; D012179:Retirement / Q000191:economics*