Objective: To investigate the incremental hourly burden of “OFF” episodes on health resource utilization (HRU) and health- related- quality of life (HRQoL) from a real world assessment of patients with Parkinson’s disease (PD).

Background: While 70% of patients with PD experience “OFF” episodes (i.e. breakthrough motor symptoms) despite their treatments [1, 2], evidence about the incremental economic (HRU) and humanistic (HRQoL) burden and impact of “OFF” episode is lacking.

Methods: Data were drawn from the Adelphi Parkinson’s Disease Specific Programme, a cross-sectional study of 109 neurologists and their consulting patients with PD in the USA. Study measures included for analysis were annual rates of neurologist-reported (i) average OFF-time hours/day, and (ii) HRU outcomes such as hospitalizations, ER visits, ICU admissions, and total length-of-hospital stays (LOS), and (iii) patient reported HRQoL measures such as EQ 5D, EQ VAS, and the Parkinson’s Disease Questionnaire (PDQ 39). Multiple linear, logistic and negative binomial regressions, adjusted for age, sex, BMI, and comorbidities, modelled the relationship between OFF-time hours/day, and health resource use and HRQoL outcomes. Odds ratios (OR), incidence rate ratios (IRR), and regression coefficients were derived.

Results: Of the 1409 PD patients, 27.5% experienced OFF episodes (50.8% reported 2–3 OFF- hours/day and 28.9% had 4+ OFF-hours/day). Increasing OFF-hours were significantly associated with greater hospitalizations (IRR 1.41,), ER visits (IRR 1.33,), ICU admission rates (OR 1.62,) as well as total LOS (IRR 1.69) (all p<0.001). Of the 586 patients completing PRO measures, 26.6% experienced OFF episodes. Higher OFF-hours/day was associated with poorer HRQoL on all measures (EQ 5D (-0.026,), EQ VAS (-2.29)), and total PDQ 39 (+20.88)) and PDQ-39 subscales (all p<0.05)

Conclusions: This real world, cross-sectional assessment of PD patients showed that each incremental OFF-hour/day resulted in 60-70% greater ICU admission and LOS; as well as significantly poorer HRQoL. It is, therefore, hypothesized that interventions specifically targeting the reduction of OFF-time may help reduce the number of OFF-episode related ER visits, hospitalizations and may help improve HRQoL.

References: 1. Pahwa R, Lyons KE. Levodopa-related wearing-OFF in Parkinson’s disease: identification and management. Curr Med Res Opin. 2009;25(4):841–9. 2. Ramirez-Zamora A, Molho E. Treatment of motor fluctuations in Parkinson’s disease: recent developments and future directions. Expert Rev Neurother. 2014;14(1):93–103.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/incremental-hourly-burden-of-off-episodes-on-patient-quality-of-life-and-health-resource-use-among-patients-with-parkinsons-disease-a-neurologist-patient-real-world-assessm/