Utilization, surgical populations, centers, coverages, regional balance, and their influential factors of deep brain stimulation for Parkinson’s disease: a large-scale multicenter cross-sectional study from 1997 to 2021

Abstract

Background: Deep brain stimulation (DBS) is an emerging effective therapy for Parkinson’s disease (PD). However, little is known about its utilization, surgical populations, centers, coverages, regional balance, and their influential factors. Materials and methods: This large-scale multicenter cross-sectional study was conducted using a national census involving 74 Chinese centers. National DBS populations and centers for PD were investigated in 1997-2021, and regional sociodemographic features, surgical populations, related resources, and insurance policies in 2020 were explored. Results: From the first DBS surgery in 1997, a total of 38,122 PD patients from 349 centers underwent DBS by 2021, which covered 1.118% (1.108-1.129) of patients and 0.954% (0.933-0.976) of centers. Significant upward trends in the annual surgical population and coverages were observed with rapid climbing rates, while the annual surgical center and their coverage showed two growth peaks in 2002-2006 and 2010-2018, correlating with clinical approvals and new technologies. A total of 103,070 (51,165-154,975) PD patients [2.088% (1.351-2.825) coverage] and 603 (72-1,134) centers [1.356% (1.126-1.586) coverage] are predicted to conduct DBS by 2030. The new remotely programmed DBS technology was recoded as the first application in 2015 and rapidly increased to 2,771 (47.39%, 46.11-48.67) patients with 10,507 remote programming sessions annually in 2021. Provinces in the eastern and central regions had better economic status, more surgical patients, higher insurance affordability, and more related resources than those in the western and northeastern regions. Higher gross domestic product per capita (β=5.041, 3.324-6.758 and β=0.008, 0.004-0.012; all P<0.001) and more functional neurosurgery doctors (β=3.596, 0.353-6.839; P=0.031 and β=0.010, 0.002-0.017; P=0.013) positively influenced surgical populations and coverages, while higher insurance levels (β=128.888, 64.702-193.075; P<0.001) positively influenced surgical coverages. Conclusions: Although surgical populations, centers, and coverages of DBS for PD have rapidly improved and are predicted to show future increases, this is still insufficient to cover potential eligible patients. Regionally imbalanced health coverage should be given attention to promote coordinated development.

A systematic review of health disparities research in deep brain stimulation surgery for Parkinson’s disease

“…However, the high cost of DBS due to lack of insurance rendered it unaffordable for most patients in these regions. Furthermore, a large-scale multicenter study utilized data from a national census spanning 74 Chinese centers ( Meng et al, 2023 ) and similarly found that the eastern regions had significantly larger PD populations undergoing DBS compared to provinces in the western region. This discrepancy was attributed to the fact that provinces located in the eastern region demonstrated notably higher gross domestic products when compared to their counterparts in the western and northwestern regions ( Meng et al, 2023 ).…”

Deep brain stimulation of the subthalamic nucleus for Parkinson’s disease: A network imaging marker of the treatment response

“…In general, these assessments are based on dopamine responsive changes in motor scores on a standardized rating scale administered by a trained clinician [11]. However, alternative quantitative tools are needed for more objective patient selection and accurate postoperative assessment, particularly in underserved areas in which experienced clinical specialists are not readily available [12,13].…”

EEG-based biomarkers for optimizing deep brain stimulation contact configuration in Parkinson’s disease

“…With the advent of directional leads and multiple independent current-controlled (MICC) devices, the programming parameter space has increased tremendously, leading to reduction in side effects but also to increased programming time and complexity ( Ten Brinke et al, 2018 ; Vitek et al, 2020 ). Additionally, a recent study now showed that the coverages of DBS for PD are rapidly increasing and are predicted to keep increasing in the future ( Meng et al, 2023 ).…”