Cost-Effectiveness Analysis of Deep Brain Stimulation in Patients with Parkinsonʼs Disease in Japan

Kawamoto, Yukiyoshi; Mouri, Mitsuko; Taira, Takaomi; Iseki, Hiroshi; Masamune, Ken

doi:10.1016/j.wneu.2015.11.062

Cited by 21 publications

(58 citation statements)

References 30 publications

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“…The observed trends of costs and outcomes showed that the costs ascended and QoL descended sequentially at the severe state of PD (H&Y 4.0-5.0), 38,41,44,48 which is in line with previous studies. 6,25,80,81 Therefore, greater cost-effectiveness can be achieved in interventions that are initiated at an early stage than later.…”

Section: Disease Severity and Funding Sourcesupporting

confidence: 90%

“…Time was an integral factor in the cost‐effectiveness of DBS. First, taking into account the progressive nature of PD, there is a clear association between undertaking DBS in early age (60 years) and greater cost‐effectiveness ($4,740/QALY) . Second, the costs were particularly bound to the time horizon followed, with greater reductions observed after the first year of surgery .…”

Section: Discussionmentioning

confidence: 99%

“…This was further elaborated in a study from Japan where CUA was performed considering different PD stages of the patients (early, intermediate, late). 48 Using a Markov model, they showed that the ICER varied from $29,442/QALY ($70,200/QALY) in the early, increased to $26,110/QALY ($25,600/QALY) in the intermediate and dropped to $27,742/QALY ($27,200/QALY) in the late over the 10 years from a healthcare perspective.…”

Section: Deep Brain Stimulationmentioning

confidence: 99%

“…First, taking into account the progressive nature of PD, there is a clear association between undertaking DBS in early age (60 years) and greater costeffectiveness ($4,740/QALY). 46,48 Second, the costs were particularly bound to the time horizon followed, with greater reductions observed after the first year of surgery. 49,53 The findings from CUA alongside RCT stated that DBS was not considered cost-effective at first year $735,200/QALY (£468,528/ QALY), which is also confirmed by extrapolation analysis, but its ICER was expected to fall under accepted thresholds in a five-year timespan.…”

Section: Management Of Late Pdmentioning

confidence: 99%

See 3 more Smart Citations

Economic Evaluation of Interventions in Parkinson's Disease: A Systematic Literature Review

Afentou

Jarl

Gerdtham

et al. 2019

Movement Disord Clin Pract

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Background Parkinson's disease (PD) management comprises of drug treatments, surgery, and physical activity/occupational therapies to relieve PD's symptoms. The aim of this study is twofold; first, to appraise recent economic evaluation studies on PD management in order to update the existing knowledge; and second, to facilitate decision making on PD management by assessing the cost‐effectiveness of all types of PD interventions. Methods A systematic search for studies published between 2010 and 2018 was conducted. The inclusion and exclusion of the articles were based on criteria relevant to population, intervention, comparison, outcomes, and study design (PICO). The reporting quality of the articles was assessed according to Consolidated Health Economic Evaluation Reporting Standards. Results Twenty‐eight articles were included, 10 of which were evaluations of drug treatments, 10 deep brain stimulation (DBS), and eight physical/occupational therapies. Among early‐stage treatments, Ti Ji dominated all physical activity interventions; however, its cost‐effectiveness should be further explored in relation to its duration, intensity, and frequency. Multidisciplinary interventions of joint medical and nonmedical therapies provided slightly better health outcomes for the same costs. In advanced PD patients, adjunct drug treatments could become more cost‐effective if introduced during early PD and, although DBS was more cost‐effective than adjunct drug therapies, the results were time‐bound. Conclusions Conditionally, certain PD interventions are cost‐effective. However, PD progression differs in each patient; thus, the cost‐effectiveness of individually tailored combinations of interventions that could provide more time in less severe disease states and improve patients’ and caregivers’ quality of life, should be further explored.

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Section: Disease Severity and Funding Sourcesupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Deep Brain Stimulationmentioning

confidence: 99%

Section: Management Of Late Pdmentioning

confidence: 99%

See 2 more Smart Citations

Economic Evaluation of Interventions in Parkinson's Disease: A Systematic Literature Review

Afentou

Jarl

Gerdtham

et al. 2019

Movement Disord Clin Pract

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“…DBS is widely used for the treatment of medically refractory movement disorders including Parkinson's, essential tremor, and dystonia . The battery‐driven device must be replaced every 2–5 years, depending on the energy levels required to control symptoms .…”

Section: Introductionmentioning

confidence: 99%

Cost-Minimization Analysis of Deep-Brain Stimulation Using National Database of Japanese Health Insurance Claims

Akazawa

Konomura

Shiroiwa

2018

Neuromodulation: Technology at the Neural Interface

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Cost‐Effectiveness of Deep Brain Stimulation With Movement Disorders: A Systematic Review

Dang

Rowell

Connelly

2019

Movement Disord Clin Pract

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Background Background: Movement disorders (MDs) are increasingly being managed with deep brain stimulation (DBS). High-quality economic evaluations (EEs) are necessary to evaluate the cost-effectiveness of DBS. We conducted a systematic review of published EEs of the treatment of MDs with DBS. The review compares and contrasts the reported incremental cost-effectiveness ratios (ICERs) and methodology employed by trial-based evaluations (TBEs) and model-based evaluations (MBEs). Methods Methods: MeSH and search terms relevant to "MDs," "DBS," and "EEs" were used to search biomedical and economics databases. Studies that used a comparative design to evaluate DBS, including before-after studies, were included. Quality and reporting assessments were conducted independently by 2 authors. Seventeen studies that targeted Parkinson's disease (PD), dystonia, and essential tremor (ET), met our selection criteria. ResultsResults: Mean scores for methodological and reporting quality were 73% and 76%, respectively. The ICERs for DBS compared with best medical therapy to treat PD patients obtained from MBEs had a lower mean and range compared with those obtained from TBEs ($55,461-$735,192 per quality-adjusted life-year [QALY] vs. $9,301-$65,111 per QALY). Pre-post ICER for DBS to treat dystonia was $64,742 per QALY. DBS was not costeffective in treating ET compared with focused-ultrasound surgery. Cost-effectiveness outcomes were sensitive to assumptions in health utilities, surgical costs, battery life-span, model time horizons, and the discount rate. Conclusions Conclusions: The infrequent use of randomized, controlled trials to evaluate DBS efficacy, the paucity of data reporting the long-term effectiveness and/or utility of DBS, and the uncertainty surrounding cost data limit our ability to report cost-effectiveness summaries that are robust.Movement disorders (MDs) are a set of hypokinetic and hyperkinetic neurological conditions that impact the speed, fluency, quality, and quality of movement. 1,2 MDs are caused by dysfunction of the basal ganglia 1 and adversely affect quality of life (QoL). To date, no effective cure has been found. The aim of treatment, of which pharmacy remains the mainstay, 3,4 is to alleviate motor and nonmotor symptoms of MDs. Deep brain stimulation (DBS) is a reversible neurosurgical procedure that can also be effective in controlling the symptoms of Parkinson's disease (PD), 5-7 essential tremor (ET), 1,8 dystonia, 1,8 and Tourette's syndrome (TS). 3,9,10 Despite successful outcomes in many patients, DBS is associated with large upfront costs and has been associated with a range of adverse events including hemorrhage, 11,12 nervous system disorders, 13 infections, 11,13 and psychiatric disorders. 13 Economic evaluations (EEs) that compare the costs and health outcomes of new treatments with existing treatments are essential to ensuring that publicly funded medical interventions are not only safe and effective, but also cost-effective. 14 To date, published EEs of DBS have predominantly concentr...

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Cost-Effectiveness Analysis of Deep Brain Stimulation in Patients with Parkinsonʼs Disease in Japan

Cited by 21 publications

References 30 publications

Economic Evaluation of Interventions in Parkinson's Disease: A Systematic Literature Review

Economic Evaluation of Interventions in Parkinson's Disease: A Systematic Literature Review

Cost-Minimization Analysis of Deep-Brain Stimulation Using National Database of Japanese Health Insurance Claims

Cost‐Effectiveness of Deep Brain Stimulation With Movement Disorders: A Systematic Review

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