Affiliations: MedStar Georgetown University Hospital & Georgetown University Medical Center – Huntington Disease Care, Education & Research Center, Wisconsin Avenue NW, Washington, DC, USA | IMS Health, Willow Oaks Corporate Drive, Fairfax, VA, USA | University of Iowa – Department of Psychiatry, Hawkins Drive, Iowa City, IA, USA | CHDI Management/CHDI Foundation, Village Boulevard, Princeton, NJ, USA
Note:  Correspondence to: Karen E. Anderson, MD, Director, MedStar Georgetown University Hospital & Georgetown University Medical Center, Huntington Disease Care, Education & Research Center, Associate Professor, Psychiatry & Neurology, Department of Psychiatry, 2115 Wisconsin Avenue NW, Washington, DC 20007, USA. Tel.: +1 202 687 4870; Fax: +1 202 687 0694; E-mail: [email protected]
Abstract: Background: Huntington's disease (HD) is a progressive neurodegenerative disease that spans distinct disease stages over 15–20 years. Various interventions are available which may allow patients to live outside of a nursing home for a longer time. However, little is known about use of these interventions by disease stage and by insurance type. Objective: We compared use of interventions among early, middle and late stages of HD in commercial (C) and Medicaid (M) health insurance populations. Methods: HD patients (ICD-9-CM 333.4) were identified from Thomson Reuters' MarketScan C and M database (2002–2009) and hierarchically grouped into disease stages based upon the presence of defining clinical markers. Results: A total of 1,272 HD patients (752/520 C/M) were identified. While stage distribution was nearly uniform in the C database – 34.0/35.5/34.0% (early/middle/late stage) – in the M population the majority were late stage (74.0%). Overall mean age was similar between C and M populations. Among late-stage patients, more M patients resided in a nursing home (M:73.8% v. C:40.6%) and received hospice care (M:18.4% v. C:11.3%). Physical therapy (PT) and home assistance were the most frequent interventions used by middle-stage patients, however more C patients received PT (C:64.0% v. M:37.1%) while more M patients received home assistance (M:75.3% v. C:53.2%). Among late-stage patients, PT was also higher in the C population (56.3% v. 48.3%). More M patients had assistive devices at home in both middle (M:25.8% v. C:9.7%) and late stages (M:35.6% v.C:23.4%). Conclusions: Apparent interventional differences emerged which varied by disease stage and insurance type.