Nationwide analysis of real-world access to and use of device-aided therapies in Parkinson's disease: insights from the French National Healthcare Data System (2015-2021).

BACKGROUND AND

OBJECTIVES

Device-aided therapies (DAT) have significantly improved the management of Parkinson's disease (PD). They now include deep brain stimulation (DBS), levodopa-carbidopa intestinal gel (LCIG) infusion, continuous subcutaneous apomorphine infusion (CSAI), subcutaneous foslevodopa/foscarbidopa and levodopa-entacapone-carbidopa intestinal gel (LECIG) infusions. Despite established clinical benefits, disparities in DAT access and use have been reported across Europe and the USA. The PARKinson's Device-Aided-Therapies (PARK-DAT) study aimed to evaluate access to and use of DAT (DBS, LCIG and CSAI) for PD in France between 2015 and 2021 using data from the French national administrative healthcare database (Système National des Données de Santé, SNDS).

METHODS

PARK-DAT is a nationwide, retrospective observational study. Patients with PD who initiated any DAT for the first time between 2015 and 2021 were identified using an established algorithm and codes within the SNDS. Standardised incidences of DAT initiation were calculated by study period and geographical region.

RESULTS

Between 2015 and 2021 8829 patients with PD (mean age 68.7±10.3 years; 43.4% women) initiated DAT representing a 41.8% overall increase between 2015 and 2021. CSAI was the most frequently initiated therapy (6873 patients; +58.9%), followed by DBS (1592 patients; -20.7%) and LCIG (364 patients; +152.9%). Most DAT prescriptions originated from hospital centres (74.6%). Few therapy switches or combinations were observed, mainly involving CSAI. Regional analyses suggest incidence disparities in DAT access.

DISCUSSION: Unlike patterns observed in other countries, CSAI was the predominant DAT in France, while DBS use declined. Features of the French healthcare system, including favourable reimbursement and broad access to home nursing services, may account for this distinctive distribution.