Figure 1
Patient attrition.
Key: ET – essential tremor; Mo – months.
Table 1
Demographics and clinical characteristics.
| COMMERCIAL POPULATION | ||||||
|---|---|---|---|---|---|---|
| All ET PATIENTS n = 22,641 | 0 QUALIFIED ET TREATMENTS n = 11,052 | 1 QUALIFIED ET TREATMENT n = 10,195 | 2 QUALIFIED ET TREATMENTS n = 1,274 | 3+ QUALIFIED ET TREATMENTS n = 120 | All NON-ET PATIENTS n = 7,158,471 | |
| Age, mean (SD; median) | 51.6 (9.9; 54.0) | 50.9 (10.4; 54.0) | 52.1 (9.5; 55.0) | 53.7 (8.4; 56.0) | 53.6 (7.9; 56.0) | 44.3 (11.6; 45.0) |
| Age category, n (%) | ||||||
| 22–34 | 1,801 (8.0) | 1,059 (9.6) | 692 (6.8) | 47 (3.7) | 3 (2.5) | 1,722,197 (24.1) |
| 35–44 | 2,890 (12.8) | 1,518 (13.7) | 1,228 (12.1) | 130 (10.2) | 14 (11.7) | 1,717,093 (24.0) |
| 45–54 | 6,679 (29.5) | 3,180 (28.8) | 3,101 (30.4) | 361 (28.3) | 37 (30.8) | 1,990,354 (27.8) |
| 55–64 | 11,271 (49.8) | 5,295 (47.9) | 5,174 (50.8) | 736 (57.8) | 66 (55.0) | 1,728,827 (24.2) |
| Sex, n (%) | ||||||
| Male | 10,993 (48.6) | 5,673 (51.3) | 4,764 (46.7) | 518 (40.7) | 38 (31.7) | 3,328,789 (46.5) |
| Female | 11,648 (51.5) | 5,379 (48.7) | 5,431 (53.3) | 756 (59.3) | 82 (68.3) | 3,829,682 (53.5) |
| Geographic region, n (%) | ||||||
| New England | 735 (3.3) | 409 (3.7) | 287 (2.8) | 36 (2.8) | 3 (2.5) | 268,435 (3.8) |
| Middle Atlantic | 3,062 (13.5) | 1,729 (15.6) | 1,193 (11.7) | 129 (10.1) | 11 (9.2) | 943,474 (13.2) |
| East North Central | 4,168 (18.4) | 2,077 (18.8) | 1,834 (18) | 236 (18.5) | 21 (17.5) | 1,199,836 (16.8) |
| West North Central | 1,140 (5) | 518 (4.7) | 532 (5.2) | 76 (6) | 14 (11.7) | 353,120 (4.9) |
| South Atlantic | 6,663 (29.4) | 3,096 (28) | 3,149 (30.9) | 378 (29.7) | 40 (33.3) | 2,141,391 (29.9) |
| East South Central | 1,848 (8.2) | 790 (7.2) | 893 (8.8) | 153 (12) | 12 (10) | 49,7597 (7) |
| West South Central | 2,047 (9) | 905 (8.2) | 1,016 (10) | 121 (9.5) | 5 (4.2) | 677,263 (9.5) |
| Mountain | 1,405 (6.2) | 652 (5.9) | 665 (6.5) | 79 (6.2) | 9 (7.5) | 452,371 (6.3) |
| Pacific | 1,535 (6.8) | 866 (7.8) | 602 (5.9) | 62 (4.9) | 5 (4.2) | 608,616 (8.5) |
| Unknown/Missing | 38 (0.2) | 10 (0.1) | 24 (0.2) | 4 (0.3) | 0 (0) | 16,368 (0.2) |
| CCIa, mean (SD; median) | 1.0 (1.8; 0.0) | 0.9 (1.6; 0.0) | 1.2 (1.9; 0.0) | 1.6 (2.2; 1.0) | 1.9 (2.2; 1.0) | 0.5 (1.1; 0.0) |
| ET-related medications with ≥31 days’ supply, n (%) | 11,589 (51.2) | 0 (0.0) | 10,195 (100.0) | 1,274 (100.0) | 120 (100.0) | 409,170 (5.7) |
| Atenolol | 620 (5.3) | NA | 473 (4.6) | 117 (9.2) | 30 (25.0) | 83,246 (20.3) |
| Gabapentin | 2,127 (18.4) | NA | 1,445 (14.2) | 591 (46.4) | 91 (75.8) | 183,902 (44.9) |
| Primidone | 2,636 (22.7) | NA | 1,862 (18.3) | 683 (53.6) | 91 (75.8) | 845 (0.2) |
| Propranolol | 6,421 (55.4) | NA | 5,535 (54.3) | 808 (63.4) | 78 (65.0) | 61,828 (15.1) |
| Topiramate | 1,306 (11.3) | NA | 880 (8.6) | 349 (27.4) | 77 (64.2) | 89,573 (21.9) |
| Days on LOT, mean (SD; median) | 432.8 (229.0; 448.1) | NA | 445.5 (454.2; 241.0) | 350.1 (396.9; 180.0) | 234.6 (262.1; 136.0) | 369.1 (399.3; 180.0) |
| Number of unique top 50 NDCs, mean (SD; median) | 6.6 (4.5; 6.0) | 5.2 (4.0; 4.0) | 7.7 (4.4; 7.0) | 10.2 (5.0; 10.0) | 12.6 (5.3; 12.0) | 3.6 (3.4; 3.0) |
| MEDICARE POPULATION | ||||||
| ALL ET PATIENTS n = 10,343 | 0 QUALIFIED ET TREATMENTS n = 6,061 | 1 QUALIFIED ET TREATMENT n = 3,617 | 2 QUALIFIED ET TREATMENTS n = 597 | 3+ QUALIFIED ET TREATMENTS n = 68 | ALL NON-ET PATIENTS n = 429,609 | |
| Age, mean (SD; median) | 75.7 (7.0; 75.0) | 75.5 (7.2; 74.0) | 75.5 (7.1; 74.0) | 75.1 (6.6; 75.0) | 75.8 (7.0; 75.0) | 74.0 (7.1; 72.0) |
| Age category, n (%) | ||||||
| 65–74 | 5,091 (49.2) | 2,940 (48.5) | 1,820 (50.3) | 299 (50.1) | 32 (47.1) | 256,793 (59.8) |
| 75+ | 5,252 (50.8) | 3,121 (51.5) | 1,797 (49.7) | 298 (49.9) | 36 (52.9) | 172,816 (40.2) |
| Sex, n (%) | ||||||
| Male | 4,837 (46.8) | 2,846 (47.0) | 1,693 (46.8) | 269 (45.1) | 29 (42.7) | 184,833 (43.0) |
| Female | 5,506 (53.2) | 3,215 (53.0) | 1,924 (53.2) | 328 (54.9) | 39 (57.4) | 244,776 (57.0) |
| Geographic region, n (%) | ||||||
| New England | 173 (1.7) | 82 (1.4) | 76 (2.1) | 13 (2.2) | 2 (2.9) | 7,250 (1.7) |
| Middle Atlantic | 2,814 (27.2) | 1,442 (23.8) | 1,182 (32.7) | 177 (29.7) | 13 (19.1) | 117,788 (27.4) |
| East North Central | 3,889 (37.6) | 2,870 (47.4) | 862 (23.8) | 141 (23.6) | 16 (23.5) | 176,627 (41.1) |
| West North Central | 94 (0.9) | 45 (0.7) | 38 (1.1) | 8 (1.3) | 3 (4.4) | 3,790 (0.9) |
| South Atlantic | 1941 (18.8) | 944 (15.6) | 828 (22.9) | 148 (24.8) | 21 (30.9) | 70,261 (16.4) |
| East South Central | 168 (1.6) | 72 (1.2) | 79 (2.2) | 16 (2.7) | 1 (1.5) | 6,226 (1.5) |
| West South Central | 389 (3.8) | 164 (2.7) | 186 (5.1) | 33 (5.5) | 6 (8.8) | 12,997 (3) |
| Mountain | 588 (5.7) | 307 (5.1) | 240 (6.6) | 37 (6.2) | 4 (5.9) | 23,156 (5.4) |
| Pacific | 277 (2.7) | 132 (2.2) | 119 (3.3) | 24 (4) | 2 (2.9) | 11,087 (2.6) |
| Unknown/Missing | 10 (0.1) | 3 (0.1) | 7 (0.2) | 0 (0) | 0 (0) | 427 (0.1) |
| CCIa, mean (SD; median) | 2.7 (2.6; 2.0) | 2.6 (2.6; 2.0) | 2.7 (2.6; 2.0) | 3.1 (2.8; 3.0) | 3.0 (2.4; 3.0) | 1.9 (2.4; 1.0) |
| ET-related medications with ≥31 days’ supply, n (%) | 4,282 (41.4) | 0 (0.0) | 3,617 (100.0) | 597 (100.0) | 68 (100.0) | 41,562 (9.7) |
| Atenolol | 380 (8.9) | NA | 283 (7.8) | 77 (12.9) | 20 (29.4) | 15,311 (36.8) |
| Gabapentin | 1,044 (24.4) | NA | 719 (19.9) | 274 (45.9) | 51 (75.0) | 22,927 (55.2) |
| Primidone | 1,531 (35.8) | NA | 1,072 (29.6) | 401 (67.2) | 58 (85.3) | 264 (0.6) |
| Propranolol | 1,763 (41.2) | NA | 1,367 (37.8) | 352 (59.0) | 44 (64.7) | 2,589 (6.2) |
| Topiramate | 299 (7.0) | NA | 176 (4.9) | 90 (15.1) | 33 (48.5) | 1,509 (3.6) |
| Days on LOT, mean (SD; median) | 488.8 (301.5; 462.9) | NA | 479.6 (285.0; 470.5) | 423.0 (269.0; 415.0) | 249.4 (126.0; 283.3) | 484.6 (437.6; 301.0) |
| Number of unique top 50 NDCs, mean (SD; median) | 7.6 (4.1; 7.0) | 6.9 (4.0; 6.0) | 8.6 (4.1; 8.0) | 9.8 (4.1; 10.0) | 10.4 (3.6; 10.0) | 5.6 (3.7; 5.0) |
[i] a The CCI is a tool that assigns morbidity scores that reflect mortality risk to patients based upon medical conditions and was determined using a weighted value based on 1 or more diagnosis or procedure codes during follow-up for the individual conditions listed in the CCI [23].
Key: CCI – Charlson Comorbidity Index; ET – essential tremor; LOT – line of therapy; NA ‒ not available; NDC ‒ National Drug Code; SD ‒ standard deviation.
Figure 2
Comorbid diagnoses.
Key: ET – essential tremor.
Table 2
All-cause healthcare resource utilization and costs.
| COMMERCIAL POPULATION | ||||||
|---|---|---|---|---|---|---|
| All ET PATIENTS n = 22,641 | 0 QUALIFIED ET TREATMENTS n = 11,052 | 1 QUALIFIED ET TREATMENT n = 10,195 | 2 QUALIFIED ET TREATMENTS n = 1,274 | 3+ QUALIFIED ET TREATMENTS n = 120 | ALL NON-ET PATIENTS n = 7,158,471 | |
| Inpatient admission, n, (%) | 3,465 (15.3) | 1,390 (12.6) | 1,701 (16.7) | 341 (26.8) | 33 (27.5) | 582,100 (8.1) |
| No., mean (SD) | 1.7 (1.7) | 1.7 (1.8) | 1.7 (1.4) | 2.1 (2.9) | 1.6 (1.1) | 1.3 (0.9) |
| LOS, days, mean (SD) | 9.6 (21.6) | 9.1 (23.2) | 9.5 (18.8) | 12.6 (28.1) | 7.9 (9.7) | 4.9 (9.9) |
| Cost, mean (SD; median) | $56,671 (118,584; 28,107) | $60,297 (146,119; 27,041) | $52,516 (85,522; 28,672) | $63,550 (138,039; 29,833) | $47.029 (48,560; 32,176) | $31,968 (59,221; 16,952) |
| ED visit, n (%) | 7,615 (33.6) | 3,343 (30.2) | 3,650 (35.8) | 575 (45.1) | 47 (39.2) | 1,598,837 (22.3) |
| No., mean (SD) | 2.4 (3.5) | 2.1 (2.5) | 2.4 (3.1) | 3.4 (7.9) | 3.6 (4.6) | 1.8 (2.0) |
| Cost, mean (SD; median) | $4,983 (9,746; 2,375) | $4,282 (7,294; 2,152) | $5,279 (9,144; 2,533) | $6,955 (20,079; 3,282) | $7,529 (8,930; 4,826) | $3,312 (6,526; 1,733) |
| Pharmacy costs, mean (SD; median) | $9,462 (30,321; 1,591) | $7,240 (27,422; 872) | $10,735 (32,165; 2,129) | $16,391 (34,561; 5,413) | $23,817 (41,592; 8,441) | $4,087 (23,854; 274) |
| Total costs, mean (SD; median) | $36,241 (86,884; 12,326) | $29,670 (84,700; 9,439) | $39,603 (80,849; 14,773) | $63,765 (133,880; 28,826) | $63,575 (66,440; 29,032) | $13,780 (44,521; 3,383) |
| MEDICARE POPULATION | ||||||
| ALL ET PATIENTS n = 10,343 | 0 QUALIFIED ET TREATMENTS n = 6,061 | 1 QUALIFIED ET TREATMENT n = 3,617 | 2 QUALIFIED ET TREATMENTS n = 597 | 3+ QUALIFIED ET TREATMENTS n = 68 | All NON-ET PATIENTS n = 429,609 | |
| Inpatient admissions (n, %) | 3,312 (32.0) | 1,797 (29.6) | 1,236 (34.2) | 250 (41.9) | 29 (42.6) | 80,475 (18.7) |
| No., mean (SD) | 1.6 (1.2) | 1.6 (1.4) | 1.6 (1.0) | 1.7 (1.1) | 1.5 (0.8) | 1.4 (0.9) |
| LOS, days, mean (SD) | 7.8 (13.7) | 7.9 (15.2) | 7.6 (11.1) | 8.5 (14.9) | 6.5 (4.1) | 6.4 (10.5) |
| Cost, mean (SD; median) | $36,888 (68,056; 16,359) | $34,515 (63,396; 16,087) | $39,157 (73,464; 16,181) | $41,299 (69,164; 20,100) | $49,141 (91,610; 18,015) | $30,128 (61,242; 13,039) |
| ED visit (n, %) | 4,858 (47.0) | 2,732 (45.1) | 1,771 (49.0) | 319 (53.4) | 36 (52.9) | 136,912 (31.9) |
| No. (mean, SD) | 2.6 (2.6) | 2.7 (2.8) | 2.6 (2.4) | 2.6 (2.5) | 2.3 (1.6) | 2.1 (2.1) |
| Cost, mean (SD; median) | $4,736 (10,896; 1,403) | $4,061 (9,241; 1,294) | $5,531 (12,524; 1,520) | $6,130 (13,921; 1,785) | $4,460 (5,635; 2,441) | $2,929 (7,032; 850) |
| Pharmacy costs, mean (SD; median) | $8,739 (25,180; 2,714) | $7,756 (24,413; 1,944) | $9,739 (26,293; 3,731) | $11,639 (25,331; 5,675) | $15,644 (24,562; 6,300) | $5,765 (20,612; 1,092) |
| Total costs, mean (SD; median) | $43,778 (81,894; 19,141) | $37,300 (68,867; 16,218) | $ 50,873 (95,858; 22,295) | $ 50,873 (95,858; 22,295) | $73,212 (97,801; 34,147) | $24,626 (64,431; 8,380) |
[i] Key: ED ‒ emergency department; ET – essential tremor; NA ‒ not available; No. – number; SD ‒ standard deviation.
Figure 3
Mean all-cause costs.
Key: ER – emergency room; ET – essential tremor.
Figure 4
Treatment patterns (A) and pharmacotherapy burden (B).
Key: ET – essential tremor; GABA – gabapentin; PRIM – primidone; PROP – propranolol; TOPI – topiramate.