Cost-minimisation model of magnetic resonance-guided focussed ultrasound therapy compared to unilateral deep brain stimulation for essential tremor treatment in Japan

Igarashi, Ataru; Tanaka, Midori; Abe, Keiichi; Richard, L.; Peirce, Vivian; Yamada, Kazumichi

doi:10.1371/journal.pone.0219929

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…This measure can be calculated from routine CT scans of the head. Compared to deep brain stimulation, focused ultrasound is less expensive [183,184].…”

Section: Focused Ultrasoundmentioning

confidence: 99%

Managing Essential Tremor

Hopfner

Deuschl

2020

Neurotherapeutics

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Essential tremor is one of the most common tremor syndromes. According to the recent tremor classification, tremor as a symptom is defined as an involuntary, rhythmic, oscillatory movement of a body part and is classified along two axes: axis 1-defining syndromes based on the clinical features such as historical features, tremor characteristics, associated signs, and laboratory tests; and axis 2-classifying the etiology (Bhatia et al., Mov Disord 33:75-87, 2018). The management of this condition has two major approaches. The first is to exclude treatable etiologies, as particularly during the onset of this condition the presentation of a variety of etiologies can be with monosymptomatic tremor. Once the few etiologies with causal treatments are excluded, all further treatment is symptomatic. Shared decision-making with enabling the patient to knowledgeably choose treatment options is needed to customize the management. Mild to moderate tremor severity can sometimes be controlled with occupational treatment, speech therapy of psychotherapy, or adaptation of coping strategy. First-line pharmacological treatments include symptomatic treatment with propranolol, primidone, and topiramate. Botulinum toxin is for selected cases. Invasive treatments for essential tremor should be considered for severe tremors. They are generally accepted as the most powerful interventions and provide not only improvement of tremor but also a significant improvement of life quality. The current standard is deep brain stimulation (DBS) of the thalamic and subthalamic region. Focused ultrasound thalamotomy is a new therapy attracting increasing interest. Radiofrequency lesioning is only rarely done if DBS or focused ultrasound is not possible. Radiosurgery is not well established. We present our treatment algorithm.

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“…This measure can be calculated from routine CT scans of the head. Compared to deep brain stimulation, focused ultrasound is less expensive [183,184].…”

Section: Focused Ultrasoundmentioning

confidence: 99%

Managing Essential Tremor

Hopfner

Deuschl

2020

Neurotherapeutics

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“…A Japanese study looked at costs alone and also found MRgFUS to be cheaper than DBS. 45 However, these Japanese and American studies did not ascertain ICERs. 46,47 The ICERs and outcomes for the Canadian study were similar to this study.…”

Section: Discussionmentioning

confidence: 97%

“…The 2019 Japanese cost minimisation study (no quality of life estimate) was performed over 1 year. 47 MRgFUS was determined cost-saving (£2,892; converted 2018 JPY400,380); the total costs per procedure for MRgFUS £15,494 (converted 2018 JPY2,145,037) and unilateral DBS were £18,386 (converted from 2018 JPY2,545,417).…”

Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of unilateral magnetic resonance-guided focused ultrasound in comparison with unilateral deep brain stimulation for the treatment of medically refractory essential tremor in England

Jameel

Meiwald

Bain

et al. 2022

BJR

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Objectives: This study aims to ascertain the cost effectiveness of Magnetic Resonance Guided focused Ultrasound (MRgFUS) for the treatment of medically refractory Essential Tremor (mrET) in England. Essential Tremor (ET) is the most common movement disorder affecting approximately 1 million in the United Kingdom causing considerable societal impact affecting patients, carers and the wider health-service. Medical treatment has mixed efficacy with approximately 25–55% of ET medication refractory. Deep Brain Stimulation (DBS), is a proven neurosurgical treatment however the risks of surgery and anaesthesia mean some patients are ineligible.MRgFUS is an emerging non-invasive technique that causes tremor suppression by thermal ablation of tremor-sensitive brain tissue. Several international clinical trials have demonstrated MRgFUS is safe and clinically effective, however, to-date no cost-effectiveness study has been performed in Europe. Methods: A Markov model was used to assess two sub populations of mrET- those eligible and those ineligible for neurosurgery- in the context specific to England and its healthcare system. For those eligible for neurosurgery, MRgFUS was compared to DBS, the current standard treatment. For those ineligible for neurosurgery, MRgFUS was compared to treatment with medication alone. The model calculated the Incremental Cost-Effectiveness Ratio (ICER) with appropriate sensitivity and scenario analyses. Results: For those eligible for neurosurgery: In the model base case the MRgFUS was economically dominant compared to DBS; MRgFUS was less costly (£19,779 vs £62,348) and more effective generating 0.03 additional quality-adjusted life-years (QALYs) per patient (3.71 vs 3.68) over the 5 year time horizon. For those eligible for neurosurgery: In the model base case, MRgFUS cost over £16,000 per patient more than medication alone (£19,779 vs £62,348) but yielded 0.77 additional QALYs per patient(3.71 vs 2.95), producing an incremental cost effectiveness ratio (ICER) of £20,851 per QALY. This ICER of £20,851 per QALY falls within the National Institute for Clinical Excellence’s (NICE) willingness to pay threshold (WTP) of 20,000–30,000 demonstrating the cost-effectiveness profile of MRgFUS. Conclusion: This study demonstrates the favourable cost-effectiveness profile of MRgFUS for the treatment of mrET in England; in both patients suitable and not suitable for neurosurgery. Advances in knowledge: The introduction of MRgFUS as a widely available ET treatment in UK is currently undergoing the necessary stages of regulatory approval. As the first European study, these favourable cost-effectiveness outcomes (notably the model base as ICER falling within NICE’s WTP) can provide a basis for future commissioning of brain MRgFUS treatments in the UK, Europe and globally.

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