Healthcare Resource Utilization and Time to Long Term Care Admission among Patients with Parkinson’s Disease Psychosis with Dementia initiated on Pimavanserin vs Quetiapine
Objectives: Pimavanserin (PIM) is the only FDA approved atypical antipsychotic (AAP) for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis (PDP); however, off-label AAPs (e.g., quetiapine, QUE) are prescribed. Real-world data are needed for healthcare utilization (HCRU) rates and time to long term care admission (LTCA) among PIM versus QUE treated patients with co-existing dementia (PDP+D).
Methods: A retrospective analysis of Parts A, B, and D claims from the 100% Medicare sample from 01/01/13 -12/31/21 was conducted. AAP-naïve PDP+D cohort who initiated ≥12-month PIM or QUE continuous monotherapy during 04/01/16-12/31/20 were propensity score matched (PSM) 1: 1 on 31 variables. All-cause HCRU rates [inpatient (IP) hospitalizations, emergency room (ER) visits, outpatient (OP) visits, LTCA] and time-to-LTCA were compared using adjusted generalized linear models (GLM) and cox proportional hazard models, respectively.
Results: Of 7,353 PDP+D patients, PIM vs QUE matched-cohorts (n=1,294 in each) had similar mean age, gender, and comorbidity profile. PIM vs QUE cohort reported lower: ≥1 all-cause IP hospitalizations (37.6% vs. 42.7%, p < 0.05), ER visits (60.1% vs. 68.2%, p < 0.05), and OP visits (90.6% vs. 91.8%, ns). Overall, PIM vs QUE had lower LTCA (22.1% vs.26.7%, p < 0.05) and greater median-days to LTCA [163 (65, 284) vs. 122 (39, 245), p < 0.05)]. Hazard ratio (95% CI) for time to LTCA was 0.77 (0.66, 0.90) for PIM vs QUE, respectively (p < 0.05).
Conclusions: PDP+D patients treated with PIM experienced lower all-cause HCRU and had a 23% lower risk of LTCA vs QUE treated PDP+D patients.
