Prospective comparative study on cost‐effectiveness of subthalamic stimulation and best medical treatment in advanced Parkinson's disease

Abstract

This is an open, prospective, longitudinal study designed to compare two cohorts of patients with advanced Parkinson's disease during 1 year, one undergoing bilateral subthalamic stimulation (STN-DBS) and the other receiving the best medical treatment (BMT), with respect to the clinical effects observed and the medical expenses produced. Assessments were done by using clinical measures and a generic health related quality of life scale. A questionnaire was used to collect direct healthcare resources. As a measure of cost-effectiveness, we calculated life years gained adjusted by health-related quality of life (QALY) and the incremental cost-effectiveness ratio (ICER). Clinical and demographic variables of both groups were comparable at baseline. Total UPDRS scores improved from 50.5 +/- 3.6 to 28.5 +/- 3.8 in STN-DBS patients and worsened from 44.3 +/- 3.3 to 54.2 +/- 4 in the control group. Pharmacological costs in the operated patients were 3,799 +/- 940 euro, while in the BMT group the costs were 13,208 +/- 4,966 euro. Other medical costs were 1,280 +/- 720 euro in the STN-DBS group and 4,017 +/- 2,962 euro in BMT patients. Nondirect medical costs were 4,079 +/- 1,289 in operated patients and 2,787 +/- 1,209 euro in the BMT group. Mean QALYs were 0.7611 +/- 0.03 in STN-DBS and 0.5401 +/- 0.06 in BMT patients. In STN-DBS patients, the ICER needed to obtain an improvement of one point in the total UPDRS score was of 239.8 euro and the ICER/QALY was of 34,389 euro. Cost-effectiveness parameters were mostly related to the degree of clinical improvement and the reduction of pharmacological costs after STN-DBS. An ICER of 34,389 euro/QALY is within appropriate limits to consider subthalamic stimulation as an efficient therapy.

The health-related, social, and economic consequences of parkinsonism: a controlled national study

“…Parkinsonism significantly reduces the quality of life of patients, family members, and caregivers [12,[34][35][36][37][38] Several studies have documented the increased direct costs of PD using different models, e.g., quality-of-life estimates [27,30,39] or model estimates [40,41], whereas others have evaluated the effect of pharmacological treatment [29,31,[42][43][44][45][46] or subthalamic stimulation [28,[47][48][49][50]. Still other studies have addressed management issues related to the care of patients with AP and PD, including the effect on caregivers and families [36,[51][52][53][54][55][56] and the influence on economic and other costs.…”

Impact of STN-DBS on life and health satisfaction in patients with Parkinson's disease

“…To date, there have been few randomised controlled trials of DBS versus medical management, and both ethical and practical concerns preclude a double-blind, placebo-controlled study 29 47. Studies comparing surgical patients with those treated with optimal medical therapy have reported efficacy data favouring DBS, but the surgical patients generally experienced more severe adverse effects 3 31 48. Since our study only included patients with bilateral STN DBS, it cannot address whether unilateral stimulation or an alternate target, such as the globus pallidus, would be preferable 3 30 49–51.…”

Deep brain stimulation in Parkinson’s disease

“…While DBS related expenses such as the hardware, surgery, post-surgical programming visits and personal care-giving are relevant [88], STN DBS seems economically more beneficial than optimal medical management through a decrease in drug requirement and cost as well as a reduction in nursing care cost [58,89-91]. No such data exist for GPi DBS.…”