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

Abstract

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.

Fibrinogen and hypertension are key factors associated with tremor relieve and recurrence in the ET patients subjected with MRgFUS thalamotomy

“…These alterations can be sensitively captured in diagnostic ultrasound such as time-harmonic ultrasound elastography, so whether there is an impact on high-intensity focused ultrasound is currently unclear. (3) The hypertension may also impact on the long-term brain remodeling after minor brain lesion therapy such as thalamectomy. Our series of works have demonstrated topological changes in regional structural and functional connectivity networks due to Vim lesion and potential dopaminergic mechanisms.…”

“…Thalamotomy by MRgFUS touts numerous advantages, including minimal invasiveness, preservation of surrounding tissue, and precise millimeter-level targeting [2]. Numerous studies have substantiated that MRgFUS thalamotomy not only delivered tremor relieve exceeding 78% for medically refractory essential tremor (ET) and over 85% improvement for tremor-dominant Parkinson’s disease (PD) [2], but also saved about 68.28% expenses and 0.03 additional quality-adjusted life-years (QALYs) per patient [3]. These breakthroughs have resulted in the wide approval of MRgFUS devices for addressing movement disorders by multiple regulatory agencies.…”

Public Perceptions of Neurotechnologies Used to Target Mood, Memory, and Motor Symptoms

“…Given the substantial financial costs associated with many of these treatments, this is an important potential barrier to access and uptake that should be considered in future work. [79][80][81] All rights reserved. No reuse allowed without permission.…”

‘Am I fixed, am I better now?’: undergoing MR-guided focused ultrasound for essential tremor: an interpretative phenomenological analysis

“…In 2020, NHS England agreed to fund MRgFUS treatment of ET for NHS patients effective from April 2021. A recent health economic study (14) also demonstrated the favourable cost-effectiveness profile of MRgFUS for the treatment of ET in England. With MRgFUS funding in place for ET, it is important to understand patients' perspectives and experiences of this new type of treatment.…”