Go backSearch Session number: 1065

Abstract title: VA Utilization and Costs for Patients with Parkinson’s Disease

Author(s):
H Gage - Center for Health Quality, Outcomes, and Economic Research, Bedford, MA
A Hendricks - Center for Health Quality, Outcomes and Economic Research, Bedford, MA
S Zhang - Center for Health Quality, Outcomes and Economic Research, Bedford, MA
S Zhu - Center for Health Quality, Outcomes and Economic Research, Bedford, MA

Objectives: To compare utilization patterns and cost of care for VA patients with a diagnosis of Parkinson’s disease (PD) with VA patients as a whole and identify their annual total and pharmacy VA costs. We hypothesized that patients with PD would have above-average pharmacy costs.

Methods: VA national utilization (PTF, OPC) files for FY 1997-FY 1999 were searched for patients with PD diagnoses (ICD-9 332.0, 333.0, 333.1). Inpatient admissions and outpatient stops for these patients were extracted. Patient-level estimates of annual costs of care, with separate pharmacy costs, were obtained from VA budget (Allocation Resource Center) files.

Results: VA treated 55,647 people with PD in FY 1997-1999, 37,593 in FY 1999 alone. Of these, 8,906 (23.7%) had a VA hospitalization (1,624 with a PD primary diagnosis for the stay). For PD patients with any inpatient stay in 1999, the average number of hospitalizations was 2.15. Virtually all PD patients received outpatient care, averaging 16.1 visits a year (about 50% more than the VA average). There were about 2 stops per visit. VISN-level variation in outpatient care (VISN 22 was 175% of VISN 4) was positively correlated with the amount of non-primary care stops the patient received (Pearson correl coeff = 0.676), especially mental health care (correlation – 0.422). More rehabilitative services were highly correlated (0.62) with being in a therapy group and both appear to substitute for primary care. Average annual cost was $4,033 compared to $4,133 for all VA patients. Annual pharmacy costs were identical ($420).

Conclusions: About 1.5% of VA patients have a PD diagnosis. They are not more costly on average for either pharmacy or total costs, although they receive more outpatient visits.

Impact statement: This study is the first to explore utilization for a large sample of PD patients. At 10.2% of total costs, pharmacy costs in VA are a smaller proportion of total expenditures than is reported for other populations (22 – 44%). Some of this difference is due to VA’s discounts in pharmacy prices. Understanding utilization and costs is important for examinations of outcomes and cost-effectiveness of alternative regimens of PD treatment.