No abstract

No abstract

Backgro und: Recent research efforts have focused on the effects of deep brain stimulation of the subthalamic nucleus (STN DBS) for selected patients with mild-to-moderate PD experiencing motor complications. Objectives: We assessed the cost utility of subthalamic DBS compared with the best medical treatment for German patients below the age of 61 with early motor complications of PD. Methods: We applied a previously published Markov model that integrated health utilities based on EuroQoL and direct costs over patients' lifetime adjusted to the German health care payer perspective (year of costing: 2013). Effectiveness was evaluated using the Parkinson's Disease Questionnaire 39 summary index. We performed sensitivity analyses to assess uncertainty. Results:In the base-case analysis, the incremental cost-utility ratio for STN DBS compared to best medical treatment was 22,700 Euros per quality-adjusted life year gained. The time to, and costs for, battery exchange had a major effect on the incremental costutility ratios, but never exceeded a threshold of 50,000 Euros per quality-adjusted life year. Conclusions: Our decision analysis supports the fact that STN DBS at earlier stages of the disease is costeffective in patients below the age of 61 when compared with the best medical treatment in the German health care system. This finding was supported by detailed sensitivity analyses reporting robust results. Whereas the EARLYSTIM study has shown STN DBS to be superior to medical therapy with respect to quality --

No abstract

Background Effects of DBS on freezing of gait and other axial signs in PD patients are unclear. Objective Secondary analysis to assess whether DBS affects these symptoms within a large randomized controlled trial comparing DBS of the STN combined with best medical treatment and best medical treatment alone in patients with early motor complications (EARLYSTIM‐trial). Methods One hundred twenty‐four patients were randomized in the stimulation group and 127 patients in the best medical treatment group. Presence of freezing of gait was assessed in the worst condition based on item‐14 of the UPDRS‐II at baseline and follow‐up. The posture, instability, and gait‐difficulty subscore of the UPDRS‐III, and a gait test including quantification of freezing of gait and number of steps, were performed in both medication‐off and medication‐on conditions. Results Fifty‐two percent in both groups had freezing of gait at baseline based on UPDRS‐II. This proportion decreased in the stimulation group to 34%, but did not change in the best medical treatment group at 24 months (P = 0.018). The steps needed to complete the gait test decreased in the stimulation group and was superior to the best medical treatment group (P = 0.016). The axial signs improved in the stimulation group compared to the best medical treatment group (P < 0.01) in both medication‐off and medication‐on conditions. Conclusions Within the first 2 years of DBS, freezing of gait and other axial signs improved in the medication‐off condition compared to best medical treatment in these patients. © 2019 International Parkinson and Movement Disorder Society