Cost-Effectiveness of Subthalmic Nucleus Deep Brain Stimulation for the Treatment of Advanced Parkinson Disease in Hong Kong: A Prospective Study

Zhu, Xian Lun; Chan, Danny Tat Ming; Lau, CK; Poon, Wai-sang; Mok, Vincent; Chan, Anne; Wong, Lawrence K.S.; Yeung, Jonas; Leung, Michael; Tang, Venus; Wong, R.C.P.; Yeung, Carol K.L.

doi:10.1016/j.wneu.2014.08.051

Cited by 25 publications

(38 citation statements)

References 12 publications

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“…More cost-effective DBS systems are necessary, particularly in developing countries in which healthcare systems may not cover the cost of the device [21]. The high out-of-pocket expense required for the implantable hardware may be the chief obstacle in DBS implantation in such countries, including China, which is estimated to have 4.94 million patients with PD in 2030 [3].…”

Section: Discussionmentioning

confidence: 99%

Remotely Programmed Deep Brain Stimulation of the Bilateral Subthalamic Nucleus for the Treatment of Primary Parkinson Disease: A Randomized Controlled Trial Investigating the Safety and Efficacy of a Novel Deep Brain Stimulation System

Li¹,

Zhang²,

Gault³

et al. 2017

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) is the most commonly performed surgery for the debilitating symptoms of Parkinson disease (PD). However, DBS systems remain largely unaffordable to patients in developing countries, warranting the development of a safe, economically viable, and functionally comparable alternative. Objective: To investigate the efficacy and safety of wirelessly programmed DBS of bilateral subthalamic nucleus (STN) in patients with primary PD. Methods: Sixty-four patients with primary PD were randomly divided into test and control groups (1:1), where DBS was initiated at either 1 month or 3 months, respectively, after surgery. Safety and efficacy of the treatment were compared between on- and off-medication states 3 months after surgery. Outcome measures included analysis of Unified Parkinson's Disease Rating Scale (UPDRS) scores, duration of “on” periods, and daily equivalent doses of levodopa. All patients were followed up both 6 and 12 months after surgery. Results: Three months after surgery, significant decrease in the UPDRS motor scores were observed for the test group in the off-medication state (25.08 ± 1.00) versus the control group (4.20 ± 1.99). Conclusions: Bilateral wireless programming STN-DBS is safe and effective for patients with primary PD in whom medical management has failed to restore motor function.

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Section: Discussionmentioning

confidence: 99%

Remotely Programmed Deep Brain Stimulation of the Bilateral Subthalamic Nucleus for the Treatment of Primary Parkinson Disease: A Randomized Controlled Trial Investigating the Safety and Efficacy of a Novel Deep Brain Stimulation System

Li¹,

Zhang²,

Gault³

et al. 2017

Stereotact Funct Neurosurg

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“…1 and one cohort study [72]. Three studies conducted CUA [69,70,76], and one study conducted costconsequence analysis [75]. Two studies measured patients' natural progression over a period [71,68].…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies conducted various interventions, including drugs [69,65,70,73], provision of communitybased nurse specialists [66], provision of instructions of clinical guidelines to neurologists [67], standardised pharmaceutical care [72], adherent therapy [64], deep brain stimulation (DBS) surgery [76], and multidisciplinary rehabilitation [74]. developed by Rosser and colleagues in 1970s, is comprised of eight levels of disability (loss of function and mobility) and four levels of subjective distress, describing 29 disability/distress states [77,78].…”

Section: Resultsmentioning

confidence: 99%

“…It was chosen in the Norwegian and Swedish studies due to its wider spectrum aspects of QoL, higher sensitivity with five levels on each attribute and availability of value sets in the specific country where the study was conducted [81,82]. Among the reference measures for the assessment of psychometric properties, the PDQ-39 was the most widely used Parkinson's-specific QoL measure, reported in 9 studies [62-64, 66,67,70,71,75,76], followed by the short version of the PDQ-39, the PDQ-8 in 6 studies [55,57,58,61, 68,72], the Parkinson's Disease QUAlity of LIFe scale (PDQUALIF) was used in one study [69], the Parkinson's Disease Quality of Life questionnaire (PDQL) [71] in one, and the generic QoL instrument, the SF-36 in one [75]. The measures used in each of the included studies are presented in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies showed consistency between the EQ-5D-3L and the reference measures in terms of the evidence for whether there was a statistically significant change overtime; the reference measures included UPDRS part II ADL [65], PDQ-39 [66,67,76], PDQ-8 and H&Y [68], and HAD depression [74].…”

Section: Assessment Of Responsivenessmentioning

confidence: 99%

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Assessment of the construct validity and responsiveness of preference-based quality of life measures in people with Parkinson’s: a systematic review

Xin

McIntosh

2016

Qual Life Res

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ResultsTwenty-three of 2,758 studies were included, of which the majority evidence was for EQ-5D. Overall, good evidence of discriminant validity was demonstrated in the Health Utility Index (HUI)-3, EQ-5D-5L, EQ-5D-3L, 15D, HUI-2 and Disability and Distress Index (DDI). Nevertheless, HUI-2 and EQ-5D-3Lwere shown to be less sensitive among patients with mild Parkinson's. Moderate to strong correlations were shown between the PbQoL measures (EQ-5D-3L, EQ-5D-5L, 15D, DDI, and HUI-II) andParkinson's-specific measures. Twelve studies provided evidence for the assessment of responsiveness of EQ-5D-3L and one study for 15D, among which six studies reached inconsistent results between EQ-5D-3L and the Parkinson's-specific measures in measuring the change overtime. ConclusionsThe construct validity of the PbQoL measures was generally good, but there are concerns regarding their responsiveness to change. In Parkinson's, the inclusion of a Parkinson's-specific QoL measure or a generic but broader scoped mental and well-being focused measure to incorporate aspects not included in the common PbQoL measures is recommended. Keywords

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Neurostimulation as a promising epilepsy therapy

Lin

Wang

2017

Epilepsia Open

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SummaryThe revolution in theory, swift technological developments, and invention of new devices have driven tremendous progress in neurostimulation as a third‐line treatment for epilepsy. Over the past decades, neurostimulation took its place in the field of epilepsy as an advanced treatment technique and opened up a new world. Numerous animal studies have proven the physical efficacy of stimulation of the brain and peripheral nerves. Based on this optimistic fundamental research, new advanced techniques are being explored in clinical practice. Over the past century, drawing on the benefits brought about by vagus nerve stimulation for the treatment of epilepsy, various new neurostimulation modalities have been developed to control seizures. Clinical studies including case reports, case series, and clinical trials have been booming in the past several years. This article gives a comprehensive review of most of these clinical studies. In addition to highlighting the advantages of neurostimulation for the treatment of epilepsy, concerns with this modality and future development directions are also discussed. The biggest advantage of neurostimulation over pharmacological treatments for epilepsy is the modulation of the epilepsy network by delivering stimuli at a specific target or the “hub.” Conversely, however, a lack of knowledge of epilepsy networks and the mechanisms of neurostimulation may hinder further development. Therefore, theoretical research on the mechanism of epileptogenesis and epilepsy networks is needed in the future. Within the multiple modalities of neuromodulation, the final choice should be made after full discussion with a multidisciplinary team at a presurgical conference. Furthermore, the establishment of a neurostimulation system with standardized parameters and rigorous guidelines is another important issue. To achieve this goal, a worldwide collaboration of epilepsy centers is also suggested in the future.

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Cost-Effectiveness of Subthalmic Nucleus Deep Brain Stimulation for the Treatment of Advanced Parkinson Disease in Hong Kong: A Prospective Study

Cited by 25 publications

References 12 publications

Remotely Programmed Deep Brain Stimulation of the Bilateral Subthalamic Nucleus for the Treatment of Primary Parkinson Disease: A Randomized Controlled Trial Investigating the Safety and Efficacy of a Novel Deep Brain Stimulation System

Remotely Programmed Deep Brain Stimulation of the Bilateral Subthalamic Nucleus for the Treatment of Primary Parkinson Disease: A Randomized Controlled Trial Investigating the Safety and Efficacy of a Novel Deep Brain Stimulation System

Assessment of the construct validity and responsiveness of preference-based quality of life measures in people with Parkinson’s: a systematic review

Neurostimulation as a promising epilepsy therapy

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