Compliance with Pharmacotherapy and Direct Healthcare Costs in Patients with Parkinson’s Disease: A Retrospective Claims Database Analysis
Parkinson’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.
To 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.
A 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.
A 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).
Non-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 healthcare system because of greater resource usage compared with the compliant population. Treatments that require fewer daily doses may have the potential to improve compliance, which in turn could reduce the economic burden associated with PD.
- de Rijk MC, Launer LJ, Berger K, Breteler MM, Dartigues JF, Baldereschi M, et al. Prevalence of Parkinson’s disease in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54(11 Suppl 5):S21–3.
- Canadian Neurological Sciences Federation. Canadian guidelines on Parkinson’s disease. Can J Neurol Sci 2012;39(Suppl 4):S1–30.
- Olanow CW, Stern MB, Sethi K. The scientific and clinical basis for the treatment of Parkinson disease (2009). Neurology. 2009;72(21 Suppl 4):S1–136. CrossRef
- Lewitt PA. Levodopa for the treatment of Parkinson’s disease. N Engl J Med. 2008;359(23):2468–76. CrossRef
- Dorsey ER, Constantinescu R, Thompson JP, Biglan KM, Holloway RG, Kieburtz K, et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology. 2007;68(5):384–6. CrossRef
- Pinder RM. Drugs for Parkinson’s disease: levodopa is still the gold standard. Neuropsychiatr Dis Treat. 2008;4(1):i–ii.
- Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang AE. A five-year study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with ropinirole or levodopa. 056 Study Group. N Engl J Med. 2000;342(20):1484–91. CrossRef
- NICE. Parkinson’s disease: diagnosis and management in primary and secondary care (Internet). 2011. http://www.nice.org.uk/CG035. Cited 9 Jan 2012.
- Miyasaki JM, Martin W, Suchowersky O, Weiner W, Lang A. Initiation of treatment of Parkinson’s disease (Internet). 2006. http://www.aan.com/professionals/practice/guidelines/pda/Treatment_PD.pdf. Cited 4 Apr 2012.
- Schapira AH. Treatment options in the modern management of Parkinson disease. Arch Neurol. 2007;64(8):1083–8. CrossRef
- Pahwa R, Factor SA, Lyons KE, Ondo WG, Gronseth G, Bronte-Stewart H, et al. Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;66(7):983–95. CrossRef
- Horstink M, Tolosa E, Bonuccelli U, Deuschl G, Friedman A, Kanovsky P, et al. Review of the therapeutic management of Parkinson’s disease. Report of a joint task force of the European Federation of Neurological Societies and the Movement Disorder Society-European Section. Part I: early (uncomplicated) Parkinson’s disease. Eur J Neurol. 2006;13(11):1170–85. CrossRef
- Huse DM, Schulman K, Orsini L, Castelli-Haley J, Kennedy S, Lenhart G. Burden of illness in Parkinson’s disease. Mov Disord. 2005;20(11):1449–54. CrossRef
- Grosset KA, Bone I, Grosset DG. Suboptimal medication adherence in Parkinson’s disease. Mov Disord. 2005;20(11):1502–7. CrossRef
- Leopold NA, Polansky M, Hurka MR. Drug adherence in Parkinson’s disease. Mov Disord. 2004;19(5):513–7. CrossRef
- Tarrants ML, Denarie MF, Castelli-Haley J, Millard J, Zhang D. Drug therapies for Parkinson’s disease: a database analysis of patient compliance and persistence. Am J Geriatr Pharmacother. 2010;8(4):374–83. CrossRef
- Grosset KA, Bone I, Reid JL, Grosset D. Measuring therapy adherence in Parkinson’s disease: a comparison of methods. J Neurol Neurosurg Psychiatry. 2006;77(2):249–51. CrossRef
- Hughes DA, Bagust A, Haycox A, Walley T. Accounting for noncompliance in pharmacoeconomic evaluations. Pharmacoeconomics. 2001;19(12):1185–97. CrossRef
- Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;(2):CD000011.
- Sackett DL, Haynes RB, Gibson ES, Taylor DW, Roberts RS, Johnson AL. Patient compliance with antihypertensive regimens. Patient Couns Health Educ. 1978;1(1):18–21. CrossRef
- Grosset D. Therapy adherence issues in Parkinson’s disease. J Neurol Sci. 2010;289(1–2):115–8. CrossRef
- Grosset D, Antonini A, Canesi M, Pezzoli G, Lees A, Shaw K, et al. Adherence to antiparkinson medication in a multicenter European study. Mov Disord. 2009;24(6):826–32. CrossRef
- O’Brien JA, Ward A, Michels SL, Spyridon T, Brandt N. Economic burden associated with Parkinson disease. Drug Benefit Trends. 2009;21(6):179–90.
- PharMetrics. PharMetrics database (Internet). 2010. http://www.imshealth.com/portal/site/ims/menuitem.d248e29c86589c9c30e81c033208c22a/?vgnextoid=d6952a2e23264310VgnVCM100000ed152ca2RCRD&vgnextchannel=c03c90916e442310VgnVCM100000ed152ca2RCRD. Cited 16 Aug 2010.
- Makaroff L, Gunn A, Gervasoni C, Richy F. Gastrointestinal disorders in Parkinson's disease: prevalence and health outcomes in a US claims database. J Parkinsons Dis. 2011;1(1):65–74.
- Davis KL, Edin HM, Allen JK. Prevalence and cost of medication nonadherence in Parkinson’s disease: evidence from administrative claims data. Mov Disord. 2010;25(4):474–80. CrossRef
- Chen JJ. Parkinson’s disease: health-related quality of life, economic cost, and implications of early treatment. Am J Manag Care. 2010;16 Suppl Implications:S87–93.
- Berger BA. Assessing and interviewing patients for meaningful behavioral change: part 1. Case Manag. 2004;15(5):46–50.
- Bond WS, Hussar DA. Detection methods and strategies for improving medication compliance. Am J Hosp Pharm. 1991;48(9):1978–88.
- McKenney JM, Munroe WP, Wright JT Jr. Impact of an electronic medication compliance aid on long-term blood pressure control. J Clin Pharmacol. 1992;32(3):277–83. CrossRef
- Ley P, Jain VK, Skilbeck CE. A method for decreasing patients’ medication errors. Psychol Med. 1976;6(4):599–601. CrossRef
- Galloway R, McGuire J. Determinants of compliance with iron supplementation: supplies, side effects, or psychology? Soc Sci Med. 1994;39(3):381–90. CrossRef
- Rohsenow DJ. What place does naltrexone have in the treatment of alcoholism? CNS Drugs. 2004;18(9):547–60. CrossRef
- Garfield FB, Caro JJ. Compliance and hypertension. Curr Hypertens Rep. 1999;1(6):502–6. CrossRef
- Steinmetz A, Schwartz T, Hehnke U, Kaffarnik H. Multicenter comparison of micronized fenofibrate and simvastatin in patients with primary type IIA or IIB hyperlipoproteinemia. J Cardiovasc Pharmacol. 1996;27(4):563–70. CrossRef
- Md S, Haque S, Sahni JK, Baboota S, Ali J. New non-oral drug delivery systems for Parkinson’s disease treatment. Expert Opin Drug Deliv. 2011;8(3):359–74. CrossRef
- Di Stefano A, Sozio P, Iannitelli A, Cerasa LS. New drug delivery strategies for improved Parkinson’s disease therapy. Expert Opin Drug Deliv. 2009;6(4):389–404. CrossRef
- Llorca P-M. Discussion of prevalence and management of discomfort when swallowing pills: orodispersible tablets expand treatment options in patients with depression. Ther Deliv. 2011;2(5):611–22. CrossRef
- Sanford M, Scott LJ. Spotlight on rotigotine transdermal patch in Parkinson’s disease. Drugs Aging. 2011;28(12):1015–7. CrossRef
- Schnitzler A, Leffers KW, Hack HJ. High compliance with rotigotine transdermal patch in the treatment of idiopathic Parkinson’s disease. Parkinsonism Relat Disord. 2010;16(8):513–6. CrossRef
- Lau HS, de Boer A, Beuning KS, Porsius A. Validation of pharmacy records in drug exposure assessment. J Clin Epidemiol. 1997;50(5):619–25. CrossRef
- Salat-Foix D, Suchowersky O. The management of gastrointestinal symptoms in Parkinson’s disease. Expert Rev Neurother. 2012;12(2):239–48. CrossRef
- Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333:15–20.
- Compliance with Pharmacotherapy and Direct Healthcare Costs in Patients with Parkinson’s Disease: A Retrospective Claims Database Analysis
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Applied Health Economics and Health Policy
Volume 11, Issue 4 , pp 395-406
- Cover Date
- Print ISSN
- Online ISSN
- Springer International Publishing
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. UCB Pharma, Allée de la Recherche 60, 1070, Brussels, Belgium
- 2. Liège University, Liège, Belgium
- 3. HERON Evidence Development Ltd, Luton, UK
- 4. UCB Pharma, Smyrna, USA