Influence of Insurance Status on Long-term Outcomes of Deep Brain Stimulation for Parkinson’s Disease: A Single-center Retrospective Cohort Study
Mahnoor Haq1, Trent Yu1, Kristen Stefanescu1, Kacey Hu1, Brian Lee2, Darrin Lee2, Catherine Mark1, Xenos Mason1
1Neurology, 2Neurological Surgery, Keck School of Medicine of USC
Objective:
Examine the effect of insurance type on long-term patient-centered functional outcomes in Parkinson’s disease (PD) patients who underwent deep brain stimulation (DBS).
Background:
DBS can improve motor symptoms in medication-resistant PD. While DBS utilization is lower among non-privately insured patients, the impact of insurance on DBS outcomes remains unexplored. Analysis of interacting demographic, clinical, and programming variables, such as total electrical energy delivered (TEED), is similarly lacking.
Design/Methods:
Long-term single-center retrospective cohort study examining PD patients who received DBS care before 2024. Functional outcomes (ambulatory and living status) were compared between mutually-exclusive insurance groups. Survival and generalized linear models (GLM) assessed the effect of potential confounders, including age, insurance, disease duration and severity, and TEED trends with false-discovery-rate (FDR) correction for multiple comparisons.
Results:
123 patients were included in the analysis: private (n=73), Medicare (n=36), or Medicaid (n=13). Prior to DBS, >85% of each group lived independently. Medicaid patients exhibited faster progression to living-status dependency (e.g. home health) relative to privately-insured patients (Cox Proportional Hazards, HR 5.33, p=0.004).
When controlling for age and disease duration, faster decline in ambulatory status was associated with a higher rate of increase in TEED (GLM-Gamma, p=0.001, 1-SD standardized multiplier=0.61); a similar association with insurance type was observed (p=0.04) but did not survive FDR correction (q=0.17). In the multivariate model, insurance type was not predictive of ambulatory or dependency status at 1 or 5 years.
Conclusions:
In PD patients undergoing DBS, Medicaid insurance predicted faster progression to living-status dependency, but this effect disappeared after adjusting for disease, demographics, and DBS programming (TEED). Instead, faster increases in TEED predicted faster ambulatory decline. Insurance status remains relevant to long-term prognosis. Whether TEED changes reflect disease severity or healthcare utilization requires further study.
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