title: Costs of Parkinson's disease in a privately insured population.
abstract: BACKGROUND
  This is the first analysis to estimate the costs of commercially insured patients with Parkinson's disease (PD) in the USA. Prior analyses of PD have not examined costs in patients aged under 65 years, a majority of whom are in the workforce.
  
  
  OBJECTIVE
  Our objective was to estimate direct and indirect costs associated with PD in patients under the age of 65 years who are newly diagnosed or have evidence of advanced PD.
  
  
  METHODS
  PD patients were selected from a commercially insured claims database (N > 12,000,000; 1999-2009); workloss data were available for a sub-sample of enrollees. Newly diagnosed patients with evidence of similar disorders were excluded. Patients with evidence of advanced PD disease, including ambulatory assistance device users (PDAAD) and institutionalized (PDINST) patients, as well as newly diagnosed PD patients, were analyzed. Each PD cohort was age-, gender- and region-matched to controls without PD. Direct (i.e. insurer payments to providers) and indirect (i.e. workloss) costs were reported in $US, year 2010 values, and were descriptively compared using Wilcoxon rank sum tests.
  
  
  RESULTS
  Patients had excess mean direct PD-related costs of $US4,072 (p < 0.001; N = 781) in the year after diagnosis. The PDAAD cohort (N = 214) had excess direct PD-related costs of $US26,467 (p < 0.001) and the PDINST cohort (N = 156) had excess direct PD-related costs of $US37,410 (p < 0.001) in the year after entering these states. Outpatient care was the most expensive cost source for newly diagnosed patients, while inpatient care was the most expensive for PDAAD and PDINST patients. Excess indirect costs were $US3,311 (p < 0.05; N = 173) in the year after initial diagnosis.
  
  
  CONCLUSIONS
  Direct costs for newly diagnosed PD patients exceeded costs for controls without PD, and increased with PD progression. Direct costs were approximately 6-7 times higher in patients with advanced PD than in matched controls. Indirect costs represented 45 % of total excess costs for newly diagnosed PD patients.
authors.affiliation: Analysis Group, Inc., Boston, MA, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Johnson
authors.forename: Anna
authors.initials: A
authors.lastname: Kaltenboeck
authors.forename: Melissa
authors.initials: M
authors.lastname: Diener
authors.forename: Howard G
authors.initials: HG
authors.lastname: Birnbaum
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Grubb
authors.forename: Jane
authors.initials: J
authors.lastname: Castelli-Haley
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Siderowf
mesh_terms: D000041:Absenteeism; D000553:Ambulatory Care / Q000191:economics; D016022:Case-Control Studies; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000191:economics*; D014481:United States
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