Cost‐effectiveness of deep brain stimulation in patients with Parkinson's disease

Abstract

In addition to medical treatment, deep brain stimulation has become an alternative therapeutic option in advanced Parkinson's disease. High initial costs of surgery have to be weighted against long-term gains in health-related quality of life. The objective of this study was to assess the cost-effectiveness of deep brain stimulation compared with long-term medical treatment. We performed a cost-utility analysis using a lifetime Markov model for Parkinson's disease. Health utilities were evaluated using the EQ-5D generic health status measure. Data on effectiveness and adverse events were obtained from clinical studies, published reports, or meta-analyses. Costs were assessed from the German health care provider perspective. Both were discounted at 3% per year. Key assumptions affecting costs and health status were investigated using one-way and two-way sensitivity analyses. The lifetime incremental cost-utility ratio for deep brain stimulation was €6700 per quality-adjusted life year (QALY) and €9800 and €2500 per United Parkinson's Disease Rating Scale part II (motor experiences of daily living) and part III (motor examination) score point gained, respectively. Deep brain stimulation costs were mainly driven by the cost of surgery and of battery exchange. Health status was improved and motor complications were reduced by DBS. Sensitivity analysis revealed that battery life time was the most influential parameter, with the incremental cost-utility ratio ranging from €20,000 per QALY to deep brain stimulation dominating medical treatment. Deep brain stimulation can be considered cost-effective, offering a value-for-money profile comparable to other well accepted health care technologies. Our data support adopting and reimbursing deep brain stimulation within the German health care system.

Ablative surgery for Parkinson’s disease: Is there still a role for pallidotomy in the deep brain stimulation era?

“…Although STN-DBS is also considered to be a cost-effective procedure by several studies, most of them showed high initial costs, with values around $29,000 dollars in the first year [82][83][84][85][86][87]. Even though it may pay itself in the future, especially by reducing medication doses, patients who are not covered by private insurance or treated by a public health care system may not be able to get access to the DBS therapy due to the reasons mentioned above.…”

Medicare Coverage of Investigational Devices

“…8 Standard 6 requires that the study comply with all applicable federal regulations concerning the protection of human subjects 1 ; however, FDA approval of IDE studies is already contingent on compliance with these regulations. 8,9 As…”

Re: Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson’s Disease in the UK and Germany

“…When discussing the results of other DBS cost-effectiveness analyses in relation to their own, the authors failed to provide a full and transparent summary and discussion. They described the results of three other analyses only, Eggington et al 13 , Dams et al 14 , and Tomaszewski and Holloway 3 , but failed to discuss data reported by Valldeoriola et al 15 , and the National Collaboration Centre for Chronic Conditions 16 in the UK. It is important to note that the authors of all five studies reported incremental cost-effectiveness ratios (ICERs) that would be considered acceptable by decision-makers, being below or around the E40,000 per quality-adjusted life-year gained, the general threshold of acceptability.…”