X L Zhu1, Danny T M Chan1, Claire K Y Lau1, Wai S Poon2, Vincent C T Mok3, Anne Y Y Chan3, Lawrence K S Wong3, Jonas H M Yeung4, Michael C M Leung5, Venus Y H Tang6, Rosanna K M Wong7, Carol Yeung8. 1. Division of Neurosurgery, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong. 2. Division of Neurosurgery, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong. Electronic address: wpoon@surgery.cuhk.edu.hk. 3. Division of Neurology, Department of Medicine and Therapeutics, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong. 4. Division of Neurology, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong. 5. Department of Economics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong. 6. Division of Neurosurgery, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong; Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong Special Administrative Region, Hong Kong. 7. Department of Occupational Therapy, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong. 8. Department of Finance, and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong.
Abstract
BACKGROUND: Deep brain stimulation (DBS) is an effective but costly treatment for patients with advanced Parkinson disease (PD). This study examined the cost-effectiveness of DBS in relation to its improved effectiveness to help funding decision makers decide whether the treatment should be adopted. The incremental cost-effective ratio (ICER) per quality-adjusted life year has been benchmarked as being between US$50,000 and US$100,000 by US agencies, whereas it is less than €30,000 per quality-adjusted life year in Europe. OBJECTIVE: To provide cost-effectiveness information of subthalamic nucleus DBS for patients with advanced PD. MATERIALS: Direct medical expenses during the year before the DBS treatment were used to measure the baseline cost. Cost-effectiveness was measured by the ICER for the Unified Parkinson's Disease Rating Scale Part III and the ICER for the EuroQol Group's Health-Related Quality of Life measurement. RESULTS: Thirteen patients with advanced PD were recruited between January 2009 and January 2011. A 1-point improvement in the Unified Parkinson's Disease Rating Scale Part III score was associated with an ICER of US$926 in the first year and US$421 in the second year. A 1-point improvement on the EuroQol Group's Health-Related Quality of Life measurement was associated with an ICER of US$123,110 in the first year and US$62,846 in the second year. CONCLUSION: Cost-effectiveness of subthalamic nucleus DBS for treatment of advanced PD is greater during a 2-year period than 1 year only. These results can be used as a reference for the use of DBS for PD in a region with public health financing.
BACKGROUND: Deep brain stimulation (DBS) is an effective but costly treatment for patients with advanced Parkinson disease (PD). This study examined the cost-effectiveness of DBS in relation to its improved effectiveness to help funding decision makers decide whether the treatment should be adopted. The incremental cost-effective ratio (ICER) per quality-adjusted life year has been benchmarked as being between US$50,000 and US$100,000 by US agencies, whereas it is less than €30,000 per quality-adjusted life year in Europe. OBJECTIVE: To provide cost-effectiveness information of subthalamic nucleus DBS for patients with advanced PD. MATERIALS: Direct medical expenses during the year before the DBS treatment were used to measure the baseline cost. Cost-effectiveness was measured by the ICER for the Unified Parkinson's Disease Rating Scale Part III and the ICER for the EuroQol Group's Health-Related Quality of Life measurement. RESULTS: Thirteen patients with advanced PD were recruited between January 2009 and January 2011. A 1-point improvement in the Unified Parkinson's Disease Rating Scale Part III score was associated with an ICER of US$926 in the first year and US$421 in the second year. A 1-point improvement on the EuroQol Group's Health-Related Quality of Life measurement was associated with an ICER of US$123,110 in the first year and US$62,846 in the second year. CONCLUSION: Cost-effectiveness of subthalamic nucleus DBS for treatment of advanced PD is greater during a 2-year period than 1 year only. These results can be used as a reference for the use of DBS for PD in a region with public health financing.
Authors: Katarzyna Smilowska; Daniel J van Wamelen; Tomasz Pietrzykowski; Alexander Calvano; Carmen Rodriguez-Blazquez; Pablo Martinez-Martin; Per Odin; K Ray Chaudhuri Journal: J Parkinsons Dis Date: 2021 Impact factor: 5.568