Compliance with Pharmacotherapy and Direct Healthcare Costs in Patients with Parkinson’s Disease: A Retrospective Claims Database Analysis

Abstract

BackgroundParkinson’s disease (PD) is a progressive neurological disorder for which, at present, there is no cure. Current therapy is largely based on the use of dopamine agonists and dopamine replacement therapy, designed to control the signs and symptoms of the disease. The majority of current treatments are administered in tablet form and can involve multiple daily doses, which may contribute to sub-optimal compliance. Previous studies with small groups of patients suggest that non-compliance with treatment can result in poor response to therapy and may ultimately increase direct and indirect healthcare costs.ObjectiveTo determine the extent of non-compliance within the general PD population in the USA as well as the patient characteristics and healthcare costs associated with compliance and non-compliance.MethodsA retrospective analysis from a managed care perspective was conducted using data from the USA PharMetrics patient-centric claims database. PharMetrics claims data were complete from 31 December 2005 to 31 December 2009. Patients were included if they had at least two diagnoses for PD between 31 December 2005 and 31 December 2008, were older than 18 years of age, were continuously enrolled for at least 12 months after the date of the most recent PD diagnosis, and had no missing or invalid data. The follow-up period was the most recent 12-month block of continuous enrollment that occurred between 2006 and 2009. Patients were required to have at least one PD-related prescription within the follow-up period. The medication possession ratio (MPR) was used to categorise patients as compliant or non-compliant. Direct all-cause annual healthcare costs for patients with PD were estimated for each patient, and regression analyses were conducted to determine predictors for non-compliance.ResultsA total of 15,846 patients were included, of whom 46 % were considered to be non-compliant with their prescribed medication (MPR <0.8). Predictors of non-compliance included prescription of a medication administered in multiple daily doses (p < 0.0001), a period of <2 years since the initial PD diagnosis (p = 0.0002), a diagnosis of gastrointestinal disorder (p < 0.0001), and a diagnosis of depression (p < 0.0001). Non-compliance was also found to be related to age, with a lower odds of non-compliance in patients aged 41–80 years than in patients aged ≥81 years (p < 0.05). Although total drug mean costs were higher for compliant patients than non-compliant patients (driven mainly by the cost of PD-related medications), the mean costs associated with emergency room and inpatient visits were higher for patients non-compliant with their prescribed medication. Overall, the total all-cause annual healthcare mean cost was lower for compliant ($77,499) than for non-compliant patients ($84,949; p < 0.0001).ConclusionNon-compliance is prevalent within the general USA PD population and is associated with a recent PD diagnosis, certain comorbidities, and multiple daily treatment dosing. Non-compliance may increase the burden on the...

Uncertainty and depression in people with Parkinson's disease: A cross‐sectional study

“…Previous research has indicated that depression can affect medication adherence. Richy et al () reported that depression was a factor associated with medication adherence in a study of people with PD who took an average of 3.6 PD medications per day ( n = 15,846, mean age = 73 years). Results showed that adherence dropped as patients became more depressed.…”

“…Moreover, people with PD with depression are more likely to feel helpless, and experience greater deterioration in cognitive function and motor symptoms than people with PD without depression (Bae et al, ). Studies have found that people with PD with depression have lower medication adherence rates than people with PD without depression (Richy et al, ). Therefore, it is necessary for healthcare professionals to manage depression as medication therapy is the primary treatment for PD.…”

The use of risk sharing tools for post adoption surveillance of a non pharmacological technology in routine practice: results after one year

“…These obstacles include: providers and the industry can perceive SRCs as a threat to their income, which may stifle research and innovation; payers may be unenthusiastic because of the added burden in their administrative workload; in the case of certain technologies, concerns may exist over the balance between potential savings and monitoring costs; follow-up of relevant outcomes through validated instruments in routine practice may be difficult; and SRCs may be used for implementing technologies which lack evidence on effectiveness in specific geographic areas, while patients are denied access to them in other settings, leading to inequities across health areas within a single Health Service [13-18,71,72]. …”

“…Providers may include health care providers or, more commonly, providers of products (e.g., the industry). The pre-established goals can be defined by levels of usage of a given technology, appropriateness of use, and/or clinical outcomes [13-18]. For instance, following a SRC payments for a new drug can be partially or totally reduced if clinical outcomes in routine practice do not reach the cut-off point previously established in the SRC.…”

Medication Adherence in People With Parkinson Disease

“…Several associated factors of antiparkinsonian medication nonadherence were reported in previous studies (Daley et al, 2014;Richy et al, 2013;Wei et al, 2014). In this literature review, a conceptual framework was developed by adopting the framework entitled, ''Predictors of Medication Adherence'' .…”