The Association between Adherence to Levodopa/Carbidopa/Entacapone Therapy and Healthcare Utilization and Costs among Patients with Parkinson’s Disease A Retrospective Claims-Based Analysis

• Published in: CNS drugs Vol. 25; no. 1; pp. 53 - 66
• Main Authors: Delea, Thomas E., Thomas, Simu K., Hagiwara, May
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2011; Adis International; Wolters Kluwer Health, Inc; Springer Nature B.V
• Subjects: Adult and adolescent clinical studies; Anticonvulsants. Antiepileptics. Antiparkinson agents; Antiparkinson Agents - administration & dosage; Antiparkinson Agents - economics; Antiparkinsonian agents; Bioavailability; Biological and medical sciences; Carbidopa - administration & dosage; Carbidopa - economics; Catechols - administration & dosage; Catechols - economics; Codes; Cohort Studies; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Delivery of Health Care - economics; Delivery of Health Care - utilization; Diagnosis; Disease; Dosage and administration; Drug therapy; Economic aspects; Health Care Costs; Health care policy; Health insurance; Health maintenance organizations; Health services utilization; HMOs; Humans; Levodopa - administration & dosage; Levodopa - economics; Medical sciences; Medicare; Medicine & Public Health; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Neuropharmacology; Neurosciences; Nitriles - administration & dosage; Nitriles - economics; Organic mental disorders. Neuropsychology; Original Research Article; Parkinson Disease - drug therapy; Parkinson Disease - economics; Parkinson's disease; Patient Compliance; Patients; Pharmacology. Drug treatments; Pharmacotherapy; Pharmacy; Prescriptions; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Quality of life; Retrospective Studies; United States; North America; America; United States > US; Entacapone; Healthcare Utilization; Suboptimal Adherence; Satisfactory Adherence; Outpatient Pharmacy Claim; Agonist; Carbidopa; Parkinson disease; Catechol O-methyltransferase; Lyases; Review; Drug compliance; Carboxy-lyases; Degenerative disease; Levodopa; Human; Decarboxylase; Nervous system diseases; Drug combination; Enzyme; Transferases; Enzyme inhibitor; Antiparkinson agent; Cerebral disorder; Carbon-carbon lyases; D2 Dopamine receptor; Treatment; Methyltransferases; Follow up study; Health economy; Central nervous system disease; Extrapyramidal syndrome
• ISSN: 1172-7047; 1179-1934
• DOI: 10.2165/11538970-000000000-00000

Background:
Suboptimal adherence to long-term therapies is common and may potentially have adverse consequences on patient outcomes and healthcare costs.
Objective:
To assess the association between adherence to levodopa/carbidopa/entacapone therapy and healthcare utilization and costs in patients with Parkinson’s disease.
Methods:
A retrospective historical cohort study, conducted in the US, using a health insurance claims database, with data spanning from 1 January 2000 to 31 December 2005. Subjects included patients with Parkinson’s disease who were treated with levodopa (L), carbidopa (C) and entacapone (E) either as separate tablets (LC + E) or as a single-tablet formulation (LCE). The association between satisfactory adherence (defined as ‘proportion of days covered’ for LCE or LC+E during 1-year follow-up ≥80%) and healthcare utilization and costs was examined using multivariate regression to control for pretreatment adherence to LC and other patient characteristics.
Results:
Compared with unsatisfactory adherence (n = 598), satisfactory adherence (n = 617) was associated with 39% fewer Parkinson’s disease-related hospitalizations (95% CI 20, 54; p<0.001), 47% lower all-cause inpatient costs (95% CI 18, 65; p = 0.004) and 18% lower all-cause total costs (95% CI 11, 24; p<0.001). On an adjusted basis, all-cause total costs were $US3508 less for those with satisfactory versus unsatisfactory adherence. In both the LC + E and LCE groups, satisfactory adherence was associated with significant reductions in all-cause hospitalizations (39% and 46%, respectively), and all-cause total costs (10% and 31%, respectively). The association between adherence and total healthcare costs was stronger for patients receiving LCE.
Conclusions:
Better adherence to levodopa/carbidopa/entacapone therapy is associated with lower healthcare utilization and costs. Non-adherence to LCE is associated with a greater increase in costs than non-adherence to LC + E. Efforts should be made to ensure adherence to both therapies.