Multiple Comorbidities, Psychiatric Disorders, Healthcare Resource Utilization and Costs Among Adults with Essential Tremor: A Retrospective Observational Study in a Large US Commercially Insured and Medicare Advantage Population

Abstract

Background: Essential tremor (ET), the most common movement disorder, often impairs patients’ ability to perform activities of daily living, mental health, and quality of life. Objectives: To assess comorbidities, psychiatric disorders, healthcare resource utilization (HCRU), and costs among patients with ET compared with patients without ET. Methods: This retrospective observational study was conducted using a large US administrative claims database. Patients with ET were identified during the study period (1/1/2017–12/31/2019). The earliest claim date with ET diagnosis was identified as the index date. An index date was assigned randomly for each non-ET patient. Patients had to be at least 22 years old and be enrolled in the health plan for at least 6 months before and at least 12 months after the index date. Patients with and those without ET were matched 1:1 on age, gender, payer type, and first 3 digits of their ZIP code. Comorbidities were assessed using data within 6 months prior to the index date. Psychiatric disorders, HCRU, and costs were examined using data within 12 months after the index date. Results: The mean (SD) age of ET patients (n = 5286) was 70.8 (11.8) years, 49.1% were female, and 82.9% were Medicare Advantage members. In the 12 months following the index date, 26.0% of patients had no insurance claims for ET-related pharmacotherapy or invasive therapies. Patients with ET had a higher number of comorbidities than non-ET patients (5.3 [3.2] vs 4.0 [3.3]); a higher prevalence of psychiatric disorders (depression: 25.6% vs 15.3%; adjusted odds ratio (AOR) [95% CI], 1.56 [1.41-1.73]; anxiety: 27.7% vs 15.5%, AOR: 1.78 [1.61-1.96]); and higher total healthcare costs: $17 560 [$39 972] vs $13 237 [$27 098], adjusted cost ratio [95% CI]: 1.11 [1.06-1.16]; all P<.0001. Discussion: Highly prevalent multiple comorbidities and psychiatric disorders should be considered in the context of clinical decision-making to optimize ET management. Conclusions: This study represents the largest observational study to report ET disease and economic burdens in a real-world setting. The data demonstrate increased comorbidity, mental health, and healthcare cost burdens among ET patients compared with matched non-ET patients. These findings underscore the need for innovative care for this complex population.

Patterns of Comorbidity and Multimorbidity Among Patients With Multiple Sclerosis in a Large US Commercially Insured and Medicare Advantage Population

“…The database includes more than 20 million members and contains patient enrollment and inpatient and outpatient medical and pharmacy claims data for fully insured commercial health plan and Medicare Advantage members. 16 As this nonexperimental study did not require direct patient identification, a Limited Data Set, as defined by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, was used. The study was approved by an institutional review board.…”

Increased Medical Comorbidities in Essential Tremor—A Wake-up Call?

“…In a study of more than 5 million US veterans, patients with ET were more likely than those without ET to have numerous comorbidities. 2 Patients with ET were, in fact, more likely to have many of the comorbidities reported by Dai et al, 1 including hypertension, obesity, hyperlipidemia, diabetes mellitus, ischemic heart disease, and inflammatory bowel disease. 2 In the veteran study, post-traumatic stress disorder, anxiety, and depression were the most common psychiatric diagnoses in ET patients, with the odds ratio exceeding 2.…”

“…read with great interest the article by Dai et al 1 and was intrigued by data that demonstrated significant increases in the prevalence of numerous medical comorbidities in patients with essential tremor (ET). The authors reported that patients with ET had a higher number of comorbidities than non-ET patients (5.3 [3.2] vs 4.0 [3.3]).…”

“…The authors reported that patients with ET had a higher number of comorbidities than non-ET patients (5.3 [3.2] vs 4.0 [3.3]). 1 The study had numerous strengths. First, the team used the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code G25.0, which is more specific for ET and better able to cleanly remove patients with other tremor disorders than the prior ICD-9 code.…”

“…In response to the data presented by Dai et al, 1 there is a tendency to search for other data to provide corroborating evidence. In a study of more than 5 million US veterans, patients with ET were more likely than those without ET to have numerous comorbidities.…”