Treatment patterns and associated costs with Parkinson's disease levodopa induced dyskinesia.
OBJECTIVE
This study examined the treatment patterns, direct healthcare costs and predictors of treatment costs associated with levodopa-induced dyskinesia (LID) in Parkinson's disease (PD).


METHODS
This retrospective cohort study followed PD patients for 1-year pre- and post-onset of LID, using a large US health insurance claims database from January 1, 2004 to December 31, 2008. Patients with LID were matched to patients without LID based on propensity scores to control for potential selection bias. Descriptive statistics and bootstrap techniques were employed to assess patient demographic and clinical characteristics and costs incurred. Factors influencing treatment costs were analyzed using a generalized linear model with log-link function and gamma distribution. Costs were adjusted to 2009 prices.


RESULTS
After patients developed LID, their total treatment costs were increased from $18,645 during the 12 months preceding LID onset to $26,439 for the 12-month period subsequent to LID onset (incremental costs of $7795: P<0.001). PD-related costs increased from $3917 to $8110 (incremental costs of $4194: p<0.001) LID events, medical resource utilization, higher levodopa dosage, and use of alternative PD medications were associated with increases in total treatment costs. Few changes in medication treatment patterns were noted following the initial LID, with only slight increases in levodopa dosage and few additions of alternative agents.


CONCLUSIONS
In the United States, PD patients with LID impose a significant economic burden when compared to patients without LID. Currently available, treatment strategies for dyskinesia should be used more frequently in PD management, and new treatment strategies should be considered as they may lower healthcare costs.
College of Pharmacy, Chung-Ang University, Seoul, South Korea. dongsuh75@gmail.com
Dong-Churl
DC
Suh
Rajesh
R
Pahwa
Usha
U
Mallya
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D016208:Databases, Factual; D004409:Dyskinesia, Drug-Induced / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health; D007980:Levodopa / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
D000978:Antiparkinson Agents; D007980:Levodopa