Fall-related healthcare use and costs in neurogenic orthostatic hypotension with Parkinson's disease

Aims: To compare patient characteristics, rates, and costs of medically attended falls among patients with Parkinson's disease (PD) and probable PD plus neurogenic orthostatic hypotension (PD+nOH). Materials and methods: MarketScan Commercial and Medicare Supplemental databases (January 1, 2009-December 31, 2013) were used to identify PD and probable PD+nOH patients. The first medical or prescription claim suggesting these diagnoses served as the index date. Baseline characteristics and post-index all-cause and fall-related healthcare utilization and costs were compared between patient groups. Results: A total of 17,421 PD and 281 PD+nOH patients were identified. Compared with PD patients, PD+nOH patients were older (77 vs 74 years; p<.0001) and had more comorbidities. Pre- and post-index date, more PD+nOH patients had a medically attended fall than PD patients (25% vs 20% [p=.0159] and 30% vs 21% [p=0.0002], respectively). Fallers in both groups had similar numbers of medically attended falls 12-months pre-index (mean =1.9), but PD+nOH fallers had more falls post-index (2.5 vs 2.0; p=.0176). Compared with PD patients, more PD+nOH patients (all p<.01) had fall-related emergency department (ED) visits (18% vs 10%), hospitalizations (7% vs 3%), and non-office visit outpatient services (15% vs 10%). Adjusted total post-index medical costs for falls ($2,260 vs $1,049; p=.0002) and total all-cause costs ($31,260 vs $20,910; p<.0001) were higher for PD+nOH vs PD patients. Limitations: This study had some limitations. There is no ICD-9-CM diagnosis code for nOH, so a combination of PD and OH diagnoses (with confounding conditions excluded) served as a proxy for an nOH diagnosis. Also, the rate of falls and associated costs in these cohorts might be under-reported because only medically attended falls were evaluated. Conclusions: PD+nOH patients had a higher prevalence of pre-existing comorbidities and a higher rate of medically attended falls than those with PD alone, leading to increased costs of care.