Real-World Analysis of Healthcare Utilization, Treatment Patterns, and Economic Burden in Medicare Beneficiaries with Parkinson’s Disease: Implications by Levodopa Formulation and Disease Severity

This study aimed to evaluate healthcare utilization, costs, and treatment patterns of Medicare beneficiaries with Parkinson's disease (PD) treated with different carbidopa-levodopa regimens. A retrospective cohort study was conducted using 100% fee-for-service Medicare research identifiable claims data from 2017 to 2019. The study population included 201,241 Medicare beneficiaries aged 65-90 years with PD who received at least one prescription for a carbidopa-levodopa-containing regimen. Treatment patterns, healthcare resource utilization, and costs were analyzed, stratified by medication regimen containing levodopa and levodopa equivalent daily dose (LEDD), the latter as a proxy for disease severity. Immediate release (IR) carbidopa-levodopa was the most common initial prescription (83%). Extended release (ER) formulations had the highest mean daily dose (1140 mg, although the equivalent dose in a non-ER formulation is approximately 570 mg, in line with the other three primary regimens). Treatment persistence and cost generally increased with higher LEDD. Concomitant medication use, particularly dopamine agonists, also increased with higher LEDD. Total 3-year per patient healthcare costs were lower for patients prescribed controlled release (CR) carbidopa-levodopa (US $98,650); compared with US $116,394 for patients prescribed IR carbidopa-levodopa; US $123,650 for those prescribed CR + IR carbidopa-levodopa; and US $125,802 for ER carbidopa-levodopa. Costs tended to increase with higher LEDD, primarily driven by outpatient care and medications. This study provides comprehensive real-world evidence on carbidopa-levodopa use in Medicare beneficiaries with PD. Findings highlight the need for individualized treatment approaches, considering both symptom control and healthcare costs. Future research should focus on prospective studies to assess long-term outcomes and economic impact of different treatment strategies in PD, considering disease severity and quality of life.