Interventional Differences Among Huntington's Disease Patients by Disease Progression in Commercial and Medicaid Populations

Background: Huntington's disease (HD) is a progressive neurodegenerative disease that spans distinct disease stages over 15-20 years. Various interventions are available which may allow patients to live outside of a nursing home for a longer time. However, little is known about use of these interventions by disease stage and by insurance type. Objective: We compared use of interventions among early, middle and late stages of HD in commercial (C) and Medicaid (M) health insurance populations. Methods: HD patients (ICD-9-CM 333.4) were identified from Thomson Reuters' MarketScan C and M database (2002-2009) and hierarchically grouped into disease stages based upon the presence of defining clinical markers. Results: A total of 1,272 HD patients (752/520 C/M) were identified. While stage distribution was nearly uniform in the C database -34.0/35.5/34.0% (early/middle/late stage) -in the M population the majority were late stage (74.0%). Overall mean age was similar between C andMpopulations. Among late-stage patients, moreMpatients resided in a nursing home (M: 73.8% v. C: 40.6%) and received hospice care (M: 18.4% v. C: 11.3%). Physical therapy (PT) and home assistance were the most frequent interventions used by middle-stage patients, however more C patients received PT (C: 64.0% v. M: 37.1%) while moreMpatients received home assistance (M: 75.3% v. C: 53.2%). Among late-stage patients, PT was also higher in the C population (56.3% v. 48.3%). More M patients had assistive devices at home in both middle (M: 25.8% v. C: 9.7%) and late stages (M: 35.6% v. C: 23.4%). Conclusions: Apparent interventional differences emerged which varied by disease stage and insurance type.