Low Sustainment of High-Dose Oral Medication Regimens for Advanced Parkinson's Disease in Medicare Beneficiaries.

Autor: Dahodwala N; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA., Jahnke J; Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Pettit AR; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA., Li P; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.; Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Ladage VP; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.; Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Kandukuri PL; AbbVie Inc., North Chicago, IL, USA., Bao Y; AbbVie Inc., North Chicago, IL, USA., Zamudio J; AbbVie Inc., North Chicago, IL, USA., Jalundhwala YJ; AbbVie Inc., North Chicago, IL, USA., Doshi JA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.; Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Journal of Parkinson's disease [J Parkinsons Dis] 2021; Vol. 11 (2), pp. 675-684.
DOI: 10.3233/JPD-202147
Abstrakt: Background: Increasing doses of oral antiparkinson medications are indicated in advanced Parkinson's disease (PD), but little is known about sustainment of high-dose regimens.
Objective: To investigate sustainment of high-dose oral medication regimens in Medicare beneficiaries with incident advanced PD.
Methods: This retrospective cohort study utilized 100%fee-for-service Medicare claims from 2011-2013. We identified advanced PD using a pharmacy claims-based proxy and selected patients who initiated a new high-dose oral medication regimen (daily levodopa equivalent dose [LED] >1000 mg/day for ≥30 days) in 2012. In the following 12 months, we examined: 1) annual proportion of days covered (PDC)≥0.80 and 2) presence of a ≥ 90 day continuous gap at varying dosage thresholds: the initial >1000 mg/day, >800 mg/day, >500 mg/day, or >0 mg/day.
Results: We identified 9,405 patients with advanced PD (mean age 77.4 [SD 6.8] years; 53%men). Only 5%maintained a regimen of >1000 mg/day at PDC ≥0.80; 75% had a ≥ 90-day gap in that dosage level. At a dosage threshold of >800 mg/day, 20% had a PDC ≥0.80 and 53% had a ≥ 90-day gap; at >500 mg/day, 56% had a PDC ≥0.80 and 19%had a ≥ 90-day gap; and at >0 mg/day (any dose), 76% had a PDC ≥0.80 and only 10%had a≥90-day gap.
Conclusion: Few patients with advanced PD sustained a high-dose oral medication regimen in the year following initiation, but most sustained a substantially lower-dose regimen. Strategies to improve advanced PD treatment are needed.
Databáze: MEDLINE
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