Objective: To assess healthcare utilization (HCU) among patients (pts) with late-onset Huntington’s disease (LoHD) versus adult-onset HD (AoHD) and non-HD controls.

Background: HD typically manifests between ages 30 and 50 years (y), but LoHD can occur in pts aged ≥60y. Little is known about the relative burden of LoHD compared with AoHD.

Method: This retrospective cohort study used the IBM® MarketScan Commercial and Medicare Supplemental databases from 2008–2018. We identified pts with newly diagnosed HD, defined as having ≥1 HD diagnosis (ICD-9-CM: 333.4; ICD-10-CM: G10) from 2009–2017, aged ≥21y at first HD diagnosis (index date) with no HD claims for 12 months pre-index. Pts with HD aged 21–59y were identified as having AoHD; those ≥60y were identified as having LoHD. Pts without HD (non-HD controls) were exact matched 2:1 to pts with HD on age, sex and insurance type, and propensity score matched on Charlson Comorbidity Index (CCI), health plan, region and baseline HCU. All pts had continuous enrollment for ≥12 months pre- and post-index. Patient characteristics at baseline and HD stage (determined by diagnoses and services in claims 6 months post-index)[1] were described. Multivariable logistic regression models adjusted for age, sex, HD diagnosis, insurance type, propensity score, and interaction between HD diagnosis and age were used to estimate predicted probabilities for all-cause HCU among pts with LoHD, pts with AoHD and non-HD controls during the 12-month post-index period.

Results: In total, 763 pts with LoHD (median [interquartile range; IQR] age: 70y [63–77]; 56.5% female; mean [SD] CCI=1.49 [2.13]) were matched to 1,526 controls; 1,073 pts with AoHD (median [IQR] age: 50y [42–55]; 55.1% female; mean [SD] CCI=0.56 [1.39]) were matched to 2,146 controls. Nearly 67.4% of pts with LoHD and 49.8% of pts with AoHD had middle- or late-stage disease. After adjusting for baseline characteristics, pts with LoHD or AoHD had a significantly higher probability of HCU across all medical service categories compared with non-HD controls during the 12-month post-index period [table1]. Compared with pts with AoHD, pts with LoHD had similar probability of hospitalizations, long-term care/nursing home, skilled nursing facility and ER visits, but lower probability of physician office visits [table1].

Conclusion: Pts with LoHD and AoHD have similar HCU burden, which is significantly higher compared with those without HD.

References: 1. Divino V, et al. J Med Econ. 2013; 16:1043–50.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/healthcare-utilization-in-individuals-with-late-onset-versus-adult-onset-huntingtons-disease/