Electronic Theses and Dissertations

Date of Award


Document Type


Degree Name

Ph.D. in Pharmaceutical Sciences

First Advisor

Yi Yang

Second Advisor

Benjamin F. Banahan

Third Advisor

John P. Bentley


University of Mississippi

Relational Format



Parkinson's disease (PD) is a chronic and progressive neurodegenerative disorder which is characterized by motor and non-motor disorders. The prevalence of PD is high among elderly patients. Due to the chronic nature of PD, increasing prevalence and ageing population, it is important to understand the burden of PD at various stages of patient’s life so that value of PD therapies can be assessed. While direct healthcare costs during the life time of PD were assessed in previous studies, there is lack of information about end of life costs in PD patients. This dissertation aimed at filling the gap in literature by assessing end of life (EOL) costs in PD patients. First, the duration of EOL period in PD patients was identified through a data-driven approach using Joinpoint regression (piece-wise linear regression). We determined the EOL period in PD patients to be the 9-period prior to death. Second, we assessed the direct healthcare cost burden of PD patients during the 9-EOL period. Further, a cohort of non-PD patients with comparable demographics and baseline comorbidity burden was identified. Based on the results from generalized linear models, we found that EOL costs were significantly higher in PD patients when compared to non-PD patients. Last, we assessed the EOL costs among patients who died at hospice facilities and non-hospice facilities. In order to compare EOL costs among patients who died at hospice facilities and non-hospice facilities, we used ordinary least squares (OLS) regression and an instrumental variable regression in order to minimize the bias due to lack of randomization. While results from OLS regression indicated that patients in hospice cohort had significantly higher costs when compared to non-hospice cohort, results from IV regression indicated that costs are not significantly different in both the cohorts. Overall, our study helps understand the EOL cost burden of PD patients enrolled in Medicare so that treatment priorities can be set and value of PD therapies can be assessed.



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