Reduced long-term cost and increased patient satisfaction with rechargeable implantable pulse generators for deep brain stimulation

Abstract

OBJECTIVEDeep brain stimulation (DBS) has revolutionized the treatment of neurological disease, but its therapeutic efficacy is limited by the lifetime of the implantable pulse generator (IPG) batteries. At the end of the battery life, IPG replacement surgery is required. New IPGs with rechargeable batteries (RC-IPGs) have recently been introduced and allow for decreased reoperation rates for IPG replacements. The authors aimed to examine the merits and limitations of these devices.METHODSThe authors reviewed the medical records of patients who underwent DBS implantation at their institution. RC-IPGs were placed either during initial DBS implantation or during an IPG change. A cost analysis was performed that compared RC-IPGs with standard IPGs, and telephone patient surveys were conducted to assess patient satisfaction.RESULTSThe authors identified 206 consecutive patients from 2011 to 2016 who underwent RC-IPG placement (mean age 61 years; 67 women, 33%). Parkinson’s disease was the most common indication for DBS (n = 144, 70%), followed by essential tremor (n = 41, 20%), dystonia (n = 13, 6%), depression (n = 5, 2%), multiple sclerosis tremor (n = 2, 1%), and epilepsy (n = 1, 0.5%). DBS leads were typically placed bilaterally (n = 192, 93%) and targeted the subthalamic nucleus (n = 136, 66%), ventral intermediate nucleus of the thalamus (n = 43, 21%), internal globus pallidus (n = 21, 10%), ventral striatum (n = 5, 2%), or anterior nucleus of the thalamus (n = 1, 0.5%). RC-IPGs were inserted at initial DBS implantation in 123 patients (60%), while 83 patients (40%) were converted to RC-IPGs during an IPG replacement surgery. The authors found that RC-IPG implantation resulted in $60,900 of cost savings over the course of 9 years. Furthermore, patient satisfaction was high with RC-IPG implantation. Overall, 87.3% of patients who responded to the survey were satisfied with their device, and only 6.7% found the rechargeable component difficult to use. In patients who were switched from a standard IPG to RC-IPG, the majority who responded (70.3%) preferred the rechargeable IPG.CONCLUSIONSRC-IPGs can provide DBS patients with long-term therapeutic benefit while minimizing the need for battery replacement surgery. The authors have implanted rechargeable stimulators in 206 patients undergoing DBS surgery, and here they demonstrate the cost-effectiveness and high patient satisfaction associated with this procedure.

Subthalamic Nucleus Stimulation in Pediatric Isolated Dystonia: A 10-Year Follow-up

“…20 Thus, the risk-profile associated with pediatric STN-DBS in the present study seems to be comparable to that of other pediatric DBS treatment studies. Fortunately, the problems caused by battery depletion can nowadays be resolved by the use of new IPGs with rechargeable batteries, which reduces financial costs, reduces surgery-related health risks, and improves the patient's satisfaction with the DBS treatment, 23 especially in pediatric patient populations. 24 Nonetheless, a major goal of pediatric and adult DBS treatment studies in general remains to reduce the risk of adverse side effects while not affecting or even improving the clinical benefits of DBS.…”

Update on Current Technologies for Deep Brain Stimulation in Parkinson’s Disease

“…Some studies have reported an increased incidence of infections with repeated IPG replacements [ 69 , 70 ], but one study did not find such an association [ 71 ]. Nevertheless, the use of a rechargeable IPG over a 9-year period (the initially approved lifespan of Activa RC) has been estimated to lead to savings of $60,900 based on a single-center study involving 206 patients [ 72 ]. Since rechargeable IPGs became available, many patients have been switched to rechargeable devices, and some have even received rechargeable IPGs during initial DBS implantation [ 72 , 73 ].…”

“…Nevertheless, the use of a rechargeable IPG over a 9-year period (the initially approved lifespan of Activa RC) has been estimated to lead to savings of $60,900 based on a single-center study involving 206 patients [ 72 ]. Since rechargeable IPGs became available, many patients have been switched to rechargeable devices, and some have even received rechargeable IPGs during initial DBS implantation [ 72 , 73 ]. Patient surveys have demonstrated that the vast majority of patients find the recharging process to be easy, and the incidence of adverse events and temporary interruptions in therapy is low [ 67 , 72 , 73 ].…”

The effect of fornix deep brain stimulation in brain diseases

“…These rlPGs have a longevity of at least 15 years in contrast to the non-rechargeable IPGs showing a mean longevity of 3-5 years. The major advantage is that patients need fewer replacement surgeries while a disadvantage is that patients must charge the rIPGs a few times a week [32].…”