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Zhang H, Zhou W, Zhang D. Direct Medical Costs of Parkinson's Disease in Southern China: A Cross-Sectional Study Based on Health Insurance Claims Data in Guangzhou City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063238. [PMID: 35328925 PMCID: PMC8953775 DOI: 10.3390/ijerph19063238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022]
Abstract
Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder. This study aims to evaluate the direct medical costs of patients with PD using a large sample from an entire city and to identity the potential factors correlating with their inpatient costs in Guangzhou City, Southern China. Methods: This retrospective cross-sectional study uses data obtained from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. The total sample was comprised of 2660 patients with PD. Costs were evaluated for the total sample and by types of insurance. The composition of costs was compared between the UEBMI and URBMI subgroups. The extended estimating-equations model was applied to identify the potential impact factors influencing the inpatient costs. Results: The direct medical costs per patient with PD were CNY 14,514.9 (USD 2299.4) in 2012, consisting of inpatient costs of CNY 13,551.4 and outpatient costs of CNY 963.5. The medication costs accounted for the largest part (50.3%). The inpatient costs of PD patients under the UEBMI scheme (CNY 13,651.0) were significantly higher than those of patients in the URBMI subgroup (CNY 12,402.2) (p < 0.05). The proportion of out-of-pocket spending out of inpatient and outpatient costs for UEBMI beneficiaries (24.3% and 56.1%) was much lower than that for patients under the URBMI scheme (47.9% and 76.2%). The regression analysis suggested that types of insurance, age, hospital levels, length of stay (LOS) and comorbidities were significantly correlated with the inpatient costs of patients with PD. Conclusions: The direct medical costs of patients with PD in China were high compared to the GDP per capita in Guangzhou City and different between the two evaluated types of insurance. Patients with the UEBMI scheme, of older age, with comorbidities, staying in tertiary hospitals and with longer LOS had significantly higher inpatient costs. Thus, policymakers need to reduce the gaps between the two urban insurance schemes in benefit levels, provide support for the development of a comprehensive long-term care insurance system and promote the use of telemedicine in China.
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Affiliation(s)
- Hui Zhang
- School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, China;
- Correspondence:
| | - Wenjing Zhou
- School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, China;
| | - Donglan Zhang
- Division of Health Services Research, New York University Long Island School of Medicine, Mineola, NY 11501, USA;
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Pham Nguyen TP, Abraham DS, Thibault D, Weintraub D, Willis AW. Low continuation of antipsychotic therapy in Parkinson disease - intolerance, ineffectiveness, or inertia? BMC Neurol 2021; 21:240. [PMID: 34167473 PMCID: PMC8223332 DOI: 10.1186/s12883-021-02265-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background Antipsychotics are used in Parkinson disease (PD) to treat psychosis, mood, and behavioral disturbances. Commonly used antipsychotics differ substantially in their potential to worsen motor symptoms through dopaminergic receptor blockade. Recent real-world data on the use and continuation of antipsychotic therapy in PD are lacking. The objectives of this study are to (1) examine the continuation of overall and initial antipsychotic therapy in individuals with PD and (2) determine whether continuation varies by drug dopamine receptor blocking activity. Methods We conducted a retrospective cohort study using U.S. commercially insured individuals in Optum 2001–2019. Adults aged 40 years or older with PD initiating antipsychotic therapy, with continuous insurance coverage for at least 6 months following drug initiation, were included. Exposure to pimavanserin, quetiapine, clozapine, aripiprazole, risperidone, or olanzapine was identified based on pharmacy claims. Six-month continuation of overall and initial antipsychotic therapy was estimated by time to complete discontinuation or switching to a different antipsychotic. Cox proportional hazards models evaluated factors associated with discontinuation. Results Overall, 38.6% of 3566 PD patients in our sample discontinued antipsychotic therapy after the first prescription, 61.4% continued with overall treatment within 6 months of initiation. Clozapine use was too rare to include in statistical analyses. Overall therapy discontinuation was more likely for those who initiated medications with known dopamine-receptor blocking activity (adjusted hazard ratios 1.76 [95% confidence interval 1.40–2.20] for quetiapine, 2.15 [1.61–2.86] for aripiprazole, 2.12 [1.66–2.72] for risperidone, and 2.07 [1.60–2.67] for olanzapine), compared with serotonin receptor-specific pimavanserin. Initial antipsychotic therapy discontinuation also associated with greater dopamine-receptor blocking activity medication use – adjusted hazard ratios 1.57 (1.28–1.94), 1.88 (1.43–2.46), 2.00 (1.59–2.52) and 2.03 (1.60–2.58) for quetiapine, aripiprazole, risperidone, and olanzapine, respectively, compared with pimavanserin. Similar results were observed in sensitivity analyses. Conclusions Over one-third of individuals with PD discontinued antipsychotic therapy, especially if the initial drug has greater dopamine-receptor blocking activity. Understanding the drivers of antipsychotic discontinuation, including ineffectiveness, potentially inappropriate use, clinician inertia, patient adherence and adverse effects, is needed to inform clinical management of psychosis in PD and appropriate antipsychotic use in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02265-x.
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Affiliation(s)
- Thanh Phuong Pham Nguyen
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Blockley Hall 829, Philadelphia, PA, 19104, USA. .,Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. .,Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Danielle S Abraham
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Blockley Hall 829, Philadelphia, PA, 19104, USA.,Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dylan Thibault
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Blockley Hall 829, Philadelphia, PA, 19104, USA.,Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Blockley Hall 829, Philadelphia, PA, 19104, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Blockley Hall 829, Philadelphia, PA, 19104, USA.,Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Orayj K. Trends and Contributing Factors for Prescribing Antipsychotics in Newly Diagnosed Parkinson's Disease Patients: A Population-Based Study. Risk Manag Healthc Policy 2021; 14:2443-2452. [PMID: 34113198 PMCID: PMC8187095 DOI: 10.2147/rmhp.s313212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/23/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Psychosis is very common in later stages of Parkinson’s disease (PD) patients, but its prevalence in newly diagnosed patients is not rare. The use of antipsychotics in PD patients is complex given their association with worsening Parkinsonian motor symptoms and increased mortality rate. This study aims to examine factors that affect the use of antipsychotics in newly diagnosed PD patients and to identify changes in prescribing over time. Patients and Methods The Secure Anonymized Information Linkage (SAIL) databank was used to identify a cohort of newly diagnosed PD patients aged 40 years and older in Wales. The cohort was longitudinally examined over 17 years to determine the incidence of new antipsychotic use. Logistic regression models were used to analyze the data and were adjusted for several potential confounding variables. Results A total of 9142 PD patients were identified after applying inclusion and exclusion criteria, of whom 58.6% were male. During the first year of PD diagnosis, 12% of the patients developed psychosis and were prescribed antipsychotics. Quetiapine was the most commonly prescribed (49%), followed by risperidone (10.7%). The use of antipsychotics in newly diagnosed PD patients was significantly lower in the years 2009–2016 compared to 2000–2008 (OR 0.37, 95% CI 0.32–0.43). Other significant prescribing factors included patient’s age and history of dementia. Conclusion A dramatic decline in antipsychotic use was identified across years, showing adherence to warnings against use of antipsychotics for PD patients. Given that psychosis is prevalent in PD patients, the continuous assessment of the safety risks of antipsychotics is a matter of priority.
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Affiliation(s)
- Khalid Orayj
- Clinical Pharmacy Department, School of Pharmacy, King Khalid University, Abha, Saudi Arabia
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Iketani R, Imai S, Horiguchi H, Furushima D, Fushimi K, Yamada H. Risk stratification for physical morbidity using factors associated with atypical antipsychotic treatment in Parkinson's disease: A retrospective observational study using administrative claims data. J Clin Neurosci 2020; 76:189-194. [PMID: 32299774 DOI: 10.1016/j.jocn.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022]
Abstract
Evidence shows that atypical antipsychotics (AAPs), a treatment of psychosis in Parkinson's disease (PD), are associated with factors reflecting the severity of the disease. Therefore, we evaluated the applicability of these factors in risk stratification for physical morbidity in PD patients requiring AAPs. We implemented a nested case-control analysis using administrative claims data derived from PD inpatients in 143 National Hospitals in Japan between April 2012 and March 2017. The analysis compared PD patients exposed to AAPs with unexposed matched controls using conditional logistic regression. The cases were then stratified by the weighted score using the partial regression coefficients of extracted factors or the number of factors that they had. Physical morbidity was evaluated using length of stay (LOS) and readmission. After comparing the cases (n = 829) with the matched controls (n = 3316), 10 factors were extracted. The cases were stratified into four level groups using the weighted score, or five level groups using the number of factors. LOS was prolonged with increasing score (49.7; 58.5; 72.7; and 83.3 days) and number of factors (52.1; 52.9; 63.9; 80.7; and 79.1 days). Readmission within 30 days increased along with increasing score (5.7; 10.2; 10.2 and 12.9%) and number of factors (5.9; 9.3; 8.9; 11.3; and 14.3%). We confirmed two stratification manners for physical morbidity in PD patients requiring AAPs. These manners would be useful for considering management plan for these patients.
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Affiliation(s)
- Ryo Iketani
- Department of Drug Evaluation & Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan; Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
| | - Shinobu Imai
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan; Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Hiromasa Horiguchi
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
| | - Daisuke Furushima
- Department of Drug Evaluation & Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kiyohide Fushimi
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Drug Evaluation & Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
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Matlow JN, Bronskill SE, Gruneir A, Bell CM, Stall NM, Herrmann N, Seitz DP, Gill SS, Austin PC, Fischer HD, Fung K, Wu W, Rochon PA. Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia. J Am Geriatr Soc 2017; 65:1535-1542. [DOI: 10.1111/jgs.14844] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jeremy N. Matlow
- Women's College Research Institute Women's College HospitalToronto Ontario Canada
- Faculty of Medicine University of TorontoUniversity of Toronto Toronto Ontario Canada
| | - Susan E. Bronskill
- Women's College Research Institute Women's College HospitalToronto Ontario Canada
- Institute of Health Policy, Management and Evaluation University of TorontoToronto Ontario Canada
- Institute for Clinical Evaluative Sciences TorontoOntario Canada
| | - Andrea Gruneir
- Women's College Research Institute Women's College HospitalToronto Ontario Canada
- Institute of Health Policy, Management and Evaluation University of TorontoToronto Ontario Canada
- Institute for Clinical Evaluative Sciences TorontoOntario Canada
- Department of Family Medicine University of Alberta Edmonton, AlbertaOntario Canada
| | - Chaim M. Bell
- Institute of Health Policy, Management and Evaluation University of TorontoToronto Ontario Canada
- Institute for Clinical Evaluative Sciences TorontoOntario Canada
- Department of Medicine University of Toronto Toronto Ontario Canada
| | - Nathan M. Stall
- Department of Medicine University of Toronto Toronto Ontario Canada
| | - Nathan Herrmann
- Department of Psychiatry University of Toronto TorontoOntario Canada
| | - Dallas P. Seitz
- Institute for Clinical Evaluative Sciences Kingston Ontario
- Division of Geriatric Psychiatry Department of Psychiatry, Queen's UniversityQueen's University Kingston Ontario Canada
| | - Sudeep S. Gill
- Institute for Clinical Evaluative Sciences Kingston Ontario
- Department of Medicine Queen's University Kingston Ontario Canada
| | - Peter C. Austin
- Institute of Health Policy, Management and Evaluation University of TorontoToronto Ontario Canada
- Institute for Clinical Evaluative Sciences TorontoOntario Canada
| | - Hadas D. Fischer
- Institute for Clinical Evaluative Sciences TorontoOntario Canada
| | - Kinwah Fung
- Institute for Clinical Evaluative Sciences TorontoOntario Canada
| | - Wei Wu
- Women's College Research Institute Women's College HospitalToronto Ontario Canada
| | - Paula A. Rochon
- Women's College Research Institute Women's College HospitalToronto Ontario Canada
- Institute of Health Policy, Management and Evaluation University of TorontoToronto Ontario Canada
- Institute for Clinical Evaluative Sciences TorontoOntario Canada
- Department of Medicine University of Toronto Toronto Ontario Canada
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