Objective: To identify associations between baseline patient and disease characteristics, and longitudinal healthcare costs in Parkinson disease (PD).

Background: Disease prevalence, disability-adjusted life-years, and PD associated mortality will increase over time due to ageing populations. As such, identifying cost drivers is essential to facilitate equitable healthcare allocation.

Method: Using linked data from the National Neuroscience Institute’s Parkinson Disease Movement Disorder and administrative databases in Singapore from 2008-2017, cost drivers were identified by multivariable regression analysis. Disease course was divided into 3-year periods (phases), and healthcare costs were summated for each phase. Longitudinal linear mixed model analysis was performed to study associations of baseline factors and cost over time.

Results: A total of 1157 patients were included. The mean (SD) age of PD diagnosis was 66.7 (9.71) years. The majority of patients were male (55.7%) and Chinese (88.5%), and they were followed up for a mean (SD) duration of 5.4 (2.6) years. Mean (SD) total cost of care was incremental in accordance with phase – USD12,875 (23,391), USD15,005 (26,978), USD18,291 (30,099) for phases 1, 2, and 3, respectively. In the first 3 years of disease (phase 1), baseline age, MDS-UPDRS-II (motor aspects of experience of daily living) score and comorbidities (CCI) were associated with costs. In phase 2, age, H&Y stage, presence of hallucinations and comorbidities were associated with increased costs. In the later years (phase 3), the only associated factor for cost was male gender. Longitudinal cost associated parameters were age, MDS-UPDRS-II score, akinetic-rigid motor subtype, the presence of hallucinations, depression and comorbidities and disease duration.

Conclusion: This study has identified phase-specific and longitudinal cost drivers in a cohort of patients with PD in Singapore. In particular, age and comorbidities at diagnosis drove costs early in the disease course but became insignificant later. Male PD patients incurred more costs as disease progressed. Older patients with higher baseline MDS-UPDRS-II score, akinetic-rigid motor subtype, hallucinations, depression or comorbidities were also more likely to have a higher cost burden over time. These results will inform future cost mitigation strategies and encourage a fine balance between cost and clinical benefits.

References: n/a

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MDS Abstracts - https://www.mdsabstracts.org/abstract/drivers-of-longitudinal-healthcare-cost-in-parkinson-disease/