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Burden of Disease and Health Care Costs of Patients Over 50 with Parkinson’s Disease in a Big Real-World Database (ARCO)

      Objectives

      The aim of this study is the analysis of healthcare and clinical pathways of patients aged over 50 years with Parkinson disease, by assessing the healthcare and the economic burden of the disease.

      Methods

      From the ARCO database (a collection of administrative data of about 17 million Italian citizens), a record linkage of pharmaceutical, hospitalizations and diagnostic procedures data was performed. From a population of 3,139,687 citizens aged ≥50 years, with available data for the study period, a cohort of 42,045 patients diagnosed with Parkinson disease was selected in 2013 and followed-up over 12 months.

      Results

      Prevalence of Parkinson disease was 1.3% (mean age 77±9 years). The average per capita total expenditure was €4,441: 41% due to pharmaceutical costs, 44% to hospitalizations and 15% to specialist procedures. Anti-Parkinson drugs are the most prescribed (99%), followed by drugs for acid related disorders (60%), antithrombotic agents (59%) and antibacterials (57%). Levodopa/decarboxylase inhibitor is the most prescribed specific drug (61%), followed by Pramipexole (33%) and Melevodopa/decarboxylase inhibitor (11%). Only 1% didn’t receive any anti-Parkinson therapy. A focus on Levodopa/decarboxylase inhibitor showed that it was prescribed as a monotherapy to 42% of patients, while 20% in association with other increasing dopamine levels drugs. Patients with Parkinson are most frequently hospitalized during the one-year follow-up for “Degenerative diseases of the nervous system” (2.4%), followed by “Heart failure and shock” (1.3%). Among diagnostic procedures, medical examinations and laboratory tests are the most prescribed.

      Conclusions

      Parkinson disease represents a high burden on the Italian Health System. This study on real world data can help the health governance to improve and balance clinical and economic decisions for a new disease management based on the monitoring of the appropriateness of clinical pathways in a patient centered view.