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Retrospective Analysis of Healthcare Resource Use, Treatment Patterns, and Treatment-related Events in Patients with
Victor W Sung1, Ravi G Iyer2, Sanjay K Gandhi2
1University of Alabama at Birmingham, Department of Neurology, Division of Movement Disorders, Birmingham, AL.
Insights
Tetrabenazine was used by a small fraction of Huntington's disease (HD) patients with chorea. High discontinuation rates were observed, with a median treatment duration of 9 months in this real-world study.
Area of Science:
- Neurology
- Pharmacology
- Health Economics
Background:
- Huntington's disease (HD) is a neurodegenerative disorder causing chorea, behavioral issues, and cognitive decline.
- Tetrabenazine is an approved treatment for chorea but has tolerability concerns.
Purpose of the Study:
- To analyze the characteristics of HD patients with chorea receiving tetrabenazine.
- To evaluate real-world treatment persistence and healthcare costs associated with tetrabenazine use in HD patients.
Main Methods:
- Retrospective analysis of US claims data (MarketScan®) from 2008-2015.
- Identified patients with HD-associated chorea (ICD-9-CM 333.4) and ≥6 months pre/post-index coverage.
- Defined treatment persistence as days from initiation to discontinuation (≥60-day gap).
Main Results:
- 1644 HD patients met criteria; 9.2% (151) received tetrabenazine (mean age 54.5).
- Median tetrabenazine daily dose was 42.3 mg; 41.8% discontinued treatment within a median of 293.5 days (9 months).
- All-cause healthcare costs increased significantly post-HD diagnosis, driven by hospitalization and pharmacy expenses.
Conclusions:
- Real-world tetrabenazine use in HD patients with chorea is limited.
- High rates of treatment discontinuation suggest potential tolerability or efficacy issues.
- HD diagnosis is associated with substantial increases in healthcare utilization and costs.
Background:
Huntington's disease (HD) is a multifaceted neurodegenerative disorder characterized by involuntary movements, specifically chorea, as well as behavioral and psychiatric disturbance, and cognitive dysfunction. Tetrabenazine was the first approved treatment for chorea, although tolerability concerns exist.
Objectives:
To characterize demographic and clinical characteristics of HD patients with chorea based on tetrabenazine use and examine treatment persistence with tetrabenazine in a real-world setting.
Methods:
Patients with a claim for HD-associated chorea (ICD-9-CM code 333.4) between 1/1/08 and 9/30/15 were selected from the MarketScan® Commercial and Medicare Supplemental databases. The first diagnosis date during the study period was considered the index date, with ≥6 months of continuous medical and prescription coverage before and after the index date. Treatment persistence was defined as the number of days from initiation to discontinuation or end of follow-up period. Discontinuation was defined as a gap in therapy of ≥60 days.
Results:
1644 patients met selection criteria (mean age ± standard deviation: 54.5 ± 15.5), of which 151 (9.2%) were treated with tetrabenazine during the study period. The average (median) daily dose of tetrabenazine during the treatment period was 45.5 (42.3) mg/day. A total of 41.8% (59/141) of HD patients who initiated tetrabenazine experienced a ≥60-day gap in tetrabenazine therapy, with a median time to discontinuation of 293.5 days. During the 6-month post-index period after HD diagnosis, HD patients incurred higher all-cause healthcare costs ($20 204) vs the 6-month pre-index period ($6057), driven by higher hospitalization and pharmacy costs.
Conclusions:
A small percentage of HD patients with chorea were treated with tetrabenazine and discontinuation rates were high among those receiving treatment, with a median time to discontinuation of 9 months.
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