Objective:

The aim of the PARK-DAT study was to measure access to and use of device-aided therapies (DAT) for Parkinson's disease (PD) in France over a period extending from 2015 to 2021, using the French administrative health care database (Système National des Données de Santé /SNDS).

Background:

Device-aided therapies (DAT), which include deep brain stimulation (DBS), levodopa-carbidopa intestinal gel (LCIG) infusion and continuous subcutaneous apomorphine infusion (CSAI), are effective treatment options for advanced PD patients. Disparities in DAT access have been highlighted in several countries. 

Design/Methods:

Data were retrospectively collected from the French administrative health care database (SNDS). The incidence of DAT initiation in PD patients was calculated for each year of the study period. Incidences were also calculated by year and by region. Incidence rates were standardized by age group (every 10 years) and sex. 

Results:

8,829 patients (mean age 68,7 ±10,3 years; 43.4% women) were initiated on a DAT between 2015 and 2021 (+41.8% increase between 2015 and 2021). Among them, 6,873 were initiated on CSAI (+58.9%), 1,592 on DBS (-20.7%) and 364 on LCIG (+152.9%). Primary prescribers are hospital centers at 74.6%. A small proportion of DAT switches and combinations are observed. Regional mapping of standardized annual incidence of DAT initiation in PD patients suggests disparities in access. 

Conclusions:

Unlike in other countries, where the most widely used DAT is DBS (Poland, Norway, Germany) or LCIG (Denmark), the DAT most frequently initiated and used in France between 2015 and 2021 is CSAI, in unprecedented proportions, while the use of DBS is declining. The specific features of the French healthcare system (reimbursement rates, availability of homecare nurse providers) may explain this distribution and the high prevalence of PD patients treated with a DAT.