Background Pimavanserin is currently the only atypical antipsychotic (AAP) approved by the US Food and Drug Administration for treating hallucinations and delusions in Parkinson’s disease psychosis (PDP). Benefit and efficacy of pimavanserin have been demonstrated through clinical trials; however, understanding other real-world outcomes is needed. Objective This study evaluated healthcare resource utilization (HCRU) patterns before and after pimavanserin initiation to assess benefit and effectiveness of pimavanserin that may be seen in the real-world setting but not in clinical trials. Methods A retrospective pre-post analysis using 100% Medicare claims data (Parts A, B, and D), April 1, 2015–December 31, 2021, was conducted. The study included AAP treatment–naïve PDP patients who initiated continuous pimavanserin monotherapy (index date) within 6 months of their incident PDP diagnosis, April 1, 2016–December 31, 2020 (ie, patient identification period). Outcomes measured during the 6 months before and after pimavanserin initiation included all-cause and psychiatric-related HCRU; further categorized as inpatient, emergency room (ER), outpatient, and office visits. Significant differences in the percentage of patients with at least 1 all-cause and at least 1 psychiatric-related HCRU were evaluated using McNemar’s tests at P < .05. Results Of the 694 patients newly diagnosed with PDP who initiated pimavanserin within 6 months of PDP diagnosis, mean age was 76.9 (±6.8) years, 54.8% were male, and 78.3% had concomitant dementia. The percentage of patients with at least 1 all-cause HCRU was significantly higher during the 6 months pre-index vs post-index, with inpatient (26.1% vs 20.5%, P < .05), ER (51.3% vs 35.2%, P < .05), outpatient (83.0% vs 79.3%, P < .05), and office visits (97.4% vs 95.8%, P < .05). Similarly, the percentage of patients with at least 1 psychiatric-related HCRU was significantly higher 6 months pre-index vs post-index, with inpatient (7.8% vs 4.9%, P < .05), ER (9.7% vs 3.5%, P < .05), outpatient (23.6% vs 13.0%, P < .05), and office visits (68.7% vs 55.8%, P < .05). Conclusions Newly diagnosed PDP patients initiating pimavanserin within 6 months demonstrated significant reductions in 6-month post-index all-cause and psychiatric-related HCRU. Further analysis examining the association between time of pimavanserin initiation and the magnitude of benefits are warranted.
Rashid et al. (Fri,) studied this question.