Objective Objective: To compare the complications, healthcare utilization and costs following DBS or medical management for patients with Parkinson's disease (PD). Methods Methods: We examined healthcare utilization and costs for up to 5 years between veterans with DBS and those with medical management for PD. Veterans who received DBS between 2007 and 2013 were matched with veterans who received medical management using propensity score approaches. Healthcare utilization and costs were obtained from national VA and Medicare data sources and compared using procedures to adjust for potential differences in length of follow-up.
ResultsResults: We identified 611 veterans who had received DBS and a matched group of 611 veterans who did not undergo DBS. Among DBS patients, 59% had the electrodes and generator implanted during separate admissions. After 5 years of follow-up, average total healthcare costs, including DBS procedures and complications, were $77,131 (95% confidence interval: $66,095-$88,168; P < 0.001) higher per person for patients who received DBS ($162,489) than patients who received medical management ($85,358). In contrast, excluding the costs of the DBS procedures and complications, average total costs were not significantly different between patients who received DBS and patients who received medical management after 5 years of follow-up. Conclusions Conclusions: Healthcare costs over 5 years were higher for veterans who received DBS. These higher healthcare costs may reflect the costs of DBS procedures and any follow-up required plus greater surveillance by healthcare professionals following DBS as well as unobserved differences in the patients who received medical management or DBS.Parkinson's disease (PD) is a common progressive neurodegenerative disease. 1,2 In the United States, prevalence of PD is estimated to be 0.3% with similar prevalence rates in Europe. 3,4 Annual healthcare cost averaged $10,000 per patient. 3 For PD patients with long-term complications from dopaminergic drugs, including motor fluctuations, severe dyskinesias, medication intolerance, or refractory motor symptoms, DBS is an accepted surgical treatment for symptom management. 5,6 DBS of the STN or internal globus pallidum (GPi) have been found to be efficacious in relieving motor fluctuations and dyskinesias associated with PD, with sustained benefit. [7][8][9][10] Results from a previous cost-effectiveness analysis comparing DBS with medical management found that healthcare costs are substantially higher 1 year following DBS. 11 Projections beyond the trial estimated that cost differences between DBS and medical management would narrow 1 to 5 years after the DBS procedure, but widen after 5 years because of battery replacements; however, projections were sensitive to assumptions about future costs. 11 Cost-effectiveness analyses comparing DBS and medical management over a 5-to 15-year time using Markov models have generally found DBS a cost-effective alternative to medical management. 12,13 However, these long-term cost ...