Longitudinal Healthcare Utilization and Costs in Parkinson’s Disease: Pre-Diagnosis to 9 Years After

Article type: Research Article

Authors: Soh, Emily Ming Li^{a; 1} | Neo, Shermyn^{b; c; 1} | Saffari, Seyed Ehsan^{a; b; c} | Wong, Aidan Sheng Yong^{b; c} | Ganesan, Ganga^d | Li, Wei^{b; c} | Ng, Hwee Lan^{b; c} | Xu, Zheyu^{b; c} | Tay, Kay Yaw^{b; c} | Au, Wing Lok^{a; b; c} | Tan, Kelvin Bryan^{d; e} | Tan, Louis Chew Seng^{a; b; c; *}

Affiliations: [a] Duke-NUS Medical School, Singapore | [b] National Neuroscience Institute, Singapore | [c] Parkinson’s Foundation Center of Excellence, Singapore | [d] Policy Research and Evaluation Division, Ministry of Health, Singapore | [e] Saw Swee Hock School of Public Health, National University of Singapore, Singapore

Correspondence: [*] Correspondence to: Louis Chew Seng Tan, MBBS, FRCP, National Neuroscience Institute, 11 Jalan Tan Tock Seng, 308433. Singapore. E-mail: louis.tan.c.s@singhealth.com.sg.

Note: [1] These authors contributed equally to this work.

Abstract: Background:There is currently insufficient long-term data on costs of treatment in patients with Parkinson’s disease (PD), which is chronic and progressive, and associated with substantial healthcare costs. Identifying patterns in healthcare utilization and cost may illuminate further discussion on early intervention. Objective:To characterize long-term healthcare utilization and costs of PD in newly diagnosed patients managed by movement disorder specialists. Methods:Using a longitudinal matched-cohort study of linked data from the National Neuroscience Institute Parkinson’s disease and Movement Disorder and healthcare administrative databases in Singapore from 2008–2017, we compared healthcare utilization and costs between patients and controls matched on age, sex, race, and Charlson Comorbidity Index score. Results:1,162 patients met study inclusion criteria and 1,157 matched controls were identified. The total mean annual healthcare cost (at 2017 costs) was significantly increased in patients compared to controls from years 1–9 post-diagnosis. The increased cost was observed 2 years before diagnosis (USD2322 vs. 2052; p < 0.001). Mean annual cost attributable to PD increased from USD1854 at 1-year post-diagnosis to USD2652 at 9 years. Over 9 years, average costs were significantly higher across all domains of healthcare utilization except primary care—cost of intermediate and long-term care was increased by a factor of 2.5, specialist care by 2.3, emergency department visits by 1.6, and hospital admissions by 1.3. Conclusion:PD results in higher healthcare utilization and costs. Pre-diagnosis increase in healthcare utilization observed in patients supports the presence of prodromal PD symptoms and may present an opportunity for early diagnosis.

Keywords: Parkinson’s disease, cost-of-illness, healthcare, utilization

DOI: 10.3233/JPD-212982

Journal: Journal of Parkinson's Disease, vol. 12, no. 3, pp. 957-966, 2022