Understanding the diagnosing provider landscape for commercially insured patients with Early- or Middle-stage Huntington’s Disease and their association with healthcare utilization using retrospective claims data

Abstract

Background: Huntington’s Disease (HD) is a progressive neurodegenerative disorder with no curative therapy. Patients have a variety of symptoms, presenting movement, cognitive, and/or psychiatric impairments at the time of diagnosis. As the first step to improve the diagnosis and management for HD, it is necessary to understand the initial diagnosis of HD patients by different provider types and its potential association with health care resource utilization (HCRU) and costs after initial diagnosis. Objective: To describe the diagnosing and managing healthcare provider landscape in early- and middle-stage HD patients, and their association with HCRU and costs. Methods: We used the Merative MarketScan Commerical Claims database. Using a published claim-based algorithm, our study included adult patients who were diagnosed with either early- or middle-stage HD between July 1st, 2017 and June 30th, 2021 without any history of HD diagnosis in the past. We followed up their all-cause HCRU and costs for six months after initial diagnosis. First, we calculated the percentage of early- and middle-stage HD patients who were diagnosed by primary care providers (PCPs), neurologists, psychiatrists, or other provider types. We assessed the association of patients’ demographic and clinical characteristics with diagnosing provider type. We also assessed the frequency of post-diagnosis visits with each provider type, stratified by diagnosing provider type. By performing a series of regression models, we estimated the associations between diagnosing provider type and all-cause HCRU and costs including inpatient stays, outpatient visits, and outpatient medications. Results: There were 429 eligible patients with early- or middle-stage HD in our study. Among those, 48.0% were diagnosed by neurologists, 35.9% by PCPs, 11.7% by psychiatrists, and 4.4% by other provider types. Patients’ age and region were significantly associated with the provider type who diagnosed their HD condition. After diagnosis, we found that the number of healthcare visits with neurologists was significantly different by diagnosing providers. We did not find any significant relationships between diagnosing provider and HCRU or costs. Conclusion: Most patients with early- or middle-stage HD initiated disease management through diagnosis by either a neurologist or PCP. Initial diagnosis by specialists may improve the linkage to care and further management by specialists who may introduce multidisciplinary care.