Objective: To compare demographic and clinical characteristics, rates, and costs of medically attended falls among patients with Parkinson’s disease (PD) and probable PD and neurogenic orthostatic hypotension (PD+nOH).

Background: nOH is defined as a sustained orthostatic fall in blood pressure upon standing. It frequently occurs in patients with neurodegenerative disorders such as PD. To date, there are no comparative data for falls and associated costs in patients with PD and PD+nOH.

Methods: Data from MarketScan^® Commercial and Medicare Supplemental databases (1/1/2009–12/31/2013) were used to identify PD patients (≥1 PD diagnosis and PD prescription) and PD+nOH patients (≥1 nOH diagnosis and nOH-related prescription plus ≥1 PD diagnosis and PD prescription). The first medical or prescription claim suggesting these diagnoses served as the index date. Demographics and clinical characteristics during the 12-month pre-index period, and all-cause and fall-related healthcare utilization and costs during the 12-month post-index period were compared between patient groups.

Results: A total of 17,421 PD and 281 PD+nOH patients were identified. Compared with the PD group, the PD+nOH group was older (77 vs 74 years; P<0.0001), more likely to be male (68% vs 59%; P=0.005), more likely to have Medicare coverage (93% vs 75%; P<0.0001), and had higher Charlson Comorbidity Index scores (mean 1.5 vs 1.3; P=0.008). Pre- and post-index date, PD+nOH patients were more likely to have a medically attended fall than PD patients (25% vs 20% [P=0.016] and 30% vs 21% [P=0.0002], respectively). Fallers in both groups had a similar number of medically attended falls 12 months pre-index (mean 1.9), but PD+nOH fallers had more falls than PD fallers post-index (2.5 vs 2.0; P=0.018). Compared with PD patients, PD+nOH patients were more likely to require emergency department visits (18% vs 10%; P<0.0001) and inpatient stays (7% vs 3%; P=0.0004) because of falls. Total medical costs for falls ($2260 vs $1049; P=0.0002) and total all-cause costs ($31,260 vs $20,910; P<0.0001) were higher for PD+nOH vs PD patients.

Conclusions: Patients with PD+nOH have a higher prevalence of pre-existing comorbidities and a higher rate of medically attended falls than those with PD alone, leading to increased care costs. Future studies may determine whether these patterns persist after the introduction of new nOH treatments.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-neurogenic-orthostatic-hypotension-on-healthcare-utilization-and-costs-associated-with-falls-in-parkinsons-disease/