Orthostatic hypotension in Parkinson disease: Impact on health care utilization

Aristide Merola, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA. Electronic address: merolaae@ucmail.uc.edu.
Russell P. Sawyer, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
Carlo Alberto Artusi, Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10126, Torino, Italy.
Ritika Suri, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.Follow
Zoe Berndt, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
Jose' Ricardo Lopez-Castellanos, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
Jennifer Vaughan, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
Joaquin A. Vizcarra, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
Alberto Romagnolo, Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10126, Torino, Italy.
Alberto J. Espay, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.

Document Type

Article

Abstract

INTRODUCTION: Orthostatic hypotension (OH) represents a frequent yet overlooked source of disability in Parkinson disease (PD). In particular, its impact on health care utilization has been insufficiently examined. We sought to determine the differential health care utilization in PD patients with (PDOH+) and without OH (PDOH-). METHODS: We quantified the emergency room (ER) visits, hospitalizations, outpatient clinic evaluations, phone calls, and e-mails from PD patients on whom supine and orthostatic blood pressure (BP) measurements were obtained during routine clinical practice between June 2013 and July 2016. Comparative costs between PDOH+ and PDOH- were adjusted for age, disease duration, motor severity, levodopa equivalent daily dose, and Montreal Cognitive Assessment. RESULTS: From a total of 317 PD patients, 29.3% were classified as PDOH+ (n = 93) and 70.6% as PDOH- (n = 224) over 30.2 ± 11.0 months, in which there were 247 hospitalizations, 170 ER visits, 2386 outpatient evaluations, and 4747 telephone calls/e-mails. After-adjusting for relevant covariates, PDOH+ was associated with more hospitalization days (+285%; p = 0.041), ER visits (+152%; p = 0.045), and telephone calls/e-mails than PDOH- (+142%; p = 0.009). The overall health care-related cost in PDOH+ was 2.5-fold higher than for PDOH- ($25,205 ± $6546 vs. $9831 ± $4167/person/year; p = 0.037). CONCLUSION: OH increases health care utilization in PD independently from age, disease duration, motor severity, dopaminergic treatment, and cognitive function.

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Blood Pressure; Cohort Studies; Female; Hospitalization (statistics & numerical data); Humans; Hypotension, Orthostatic (economics, epidemiology, etiology); Male; Middle Aged; Neurologic Examination; Parkinson Disease (complications, economics, epidemiology); Patient Acceptance of Health Care; Statistics, Nonparametric

Publication Date

2-1-2018

Publication Title

Parkinsonism & related disorders

E-ISSN

1873-5126

Volume

47

First Page

45

Last Page

49

PubMed ID

29195729

Digital Object Identifier (DOI)

10.1016/j.parkreldis.2017.11.344

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