Prescribing pattern and resource utilization of monoamine oxidase-B inhibitors in Parkinson treatment: comparison between rasagiline and selegiline

Difference between selegiline and rasagiline for effectiveness in Parkinson's disease (PD) is uncertain, nevertheless their costs highly differ: rasagiline is more expensive than selegiline. This study was aimed to compare prescribing pattern and resource utilization in PD patients treated with rasagiline or selegiline. Historic cohort study, based on databases of three Italian Local Health Authorities was performed. Patients with PD and receiving rasagiline or selegiline between 01-07-2009 and 31-12-2011 were selected and followed-up for 12 months. As outcomes, and relevant costs, were evaluated: (a) anti-parkinson prescriptions; (b) hospitalization for PD and for fracture; (c) antiinflammatory and antirheumatic prescriptions; (d) antipsychotic prescriptions; (e) hospitalization for cardiovascular diseases; (f) cardiovascular prescriptions; (g) ambulatory visits or diagnostic tests. Average annual cost per patient was considered for both PD-related expenditure (a + b + c) and overall cost (a + b + c + d + e + f + g). Differences between rasagiline and selegiline were analysed by generalized linear model. Overall 1607 patients were selected: 63.7 % under selegiline and 36.2 % under rasagiline. Hospitalizations for PD occurred more in rasagiline group than in selegiline one (13.6 vs. 8.0 %, p < 0.001), whereas hospitalizations for fractures less in rasagiline group than in selegiline one (1.4 vs. 3.8 %, p = 0.005). Dopamine agonists (66.0 vs. 31.0 %, p < 0.001) and levodopa (73.9 vs. 49.0 %, p < 0.001) were prescribed more frequently in rasagiline group than in selegiline one. The choice to prescribe rasagiline produced a statistically significant increase in both overall cost (+ 2404 (sic), p < 0.001) and PD-related cost (+ 2363 (sic), p < 0.001). In conclusion, prescribing patterns and health resource utilization highly differ between rasagiline and selegiline. There is no homogeneous prescription behaviour among clinicians in preferring one or the other MOAB-I, on the basis of demographic, clinical and therapeutic characteristics of patients with PD.