Judith Dams1, Monika Balzer-Geldsetzer1, Uwe Siebert2,3,4, Günther Deuschl5, W M Michael Schuepbach6, Paul Krack7, Lars Timmermann8, Alfons Schnitzler9, Jens-Peter Reese10, Richard Dodel1,11. 1. Department of Neurology, Philipps-University Marburg, Marburg, Germany. 2. Department of Public Health, Health Services Research and HealthTechnology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria. 3. Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 4. Department of Health Policy and Management, Harvard Chan School of Public Health, Boston, Massachusetts, USA. 5. Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany. 6. Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France, and Movement Disorders Center, Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland. 7. Department of Neurology, University Hospital INSERM Unite 836, Grenoble Alpes University, Saint-Martin-d'Hères, France. 8. Department of Neurology, University Hospital Cologne, Cologne, Germany. 9. Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany. 10. Department of Medical Sociology and Social Medicine, Philipps-University Marburg, Marburg, Germany. 11. Department of Geriatrics, University Duisburg-Essen, Essen, Germany.
Abstract
BACKGROUND: Recent research efforts have focused on the effects of deep brain stimulation of the subthalamic nucleus (STN DBS) for selected patients with mild-to-moderate PD experiencing motor complications. OBJECTIVES: We assessed the cost utility of subthalamic DBS compared with the best medical treatment for German patients below the age of 61 with early motor complications of PD. METHODS: We applied a previously published Markov model that integrated health utilities based on EuroQoL and direct costs over patients' lifetime adjusted to the German health care payer perspective (year of costing: 2013). Effectiveness was evaluated using the Parkinson's Disease Questionnaire 39 summary index. We performed sensitivity analyses to assess uncertainty. RESULTS: In the base-case analysis, the incremental cost-utility ratio for STN DBS compared to best medical treatment was 22,700 Euros per quality-adjusted life year gained. The time to, and costs for, battery exchange had a major effect on the incremental cost-utility ratios, but never exceeded a threshold of 50,000 Euros per quality-adjusted life year. CONCLUSIONS: Our decision analysis supports the fact that STN DBS at earlier stages of the disease is cost-effective in patients below the age of 61 when compared with the best medical treatment in the German health care system. This finding was supported by detailed sensitivity analyses reporting robust results. Whereas the EARLYSTIM study has shown STN DBS to be superior to medical therapy with respect to quality of life for patients with early motor complications, this further analysis has shown its cost-effectiveness.
BACKGROUND: Recent research efforts have focused on the effects of deep brain stimulation of the subthalamic nucleus (STNDBS) for selected patients with mild-to-moderate PD experiencing motor complications. OBJECTIVES: We assessed the cost utility of subthalamic DBS compared with the best medical treatment for German patients below the age of 61 with early motor complications of PD. METHODS: We applied a previously published Markov model that integrated health utilities based on EuroQoL and direct costs over patients' lifetime adjusted to the German health care payer perspective (year of costing: 2013). Effectiveness was evaluated using the Parkinson's Disease Questionnaire 39 summary index. We performed sensitivity analyses to assess uncertainty. RESULTS: In the base-case analysis, the incremental cost-utility ratio for STNDBS compared to best medical treatment was 22,700 Euros per quality-adjusted life year gained. The time to, and costs for, battery exchange had a major effect on the incremental cost-utility ratios, but never exceeded a threshold of 50,000 Euros per quality-adjusted life year. CONCLUSIONS: Our decision analysis supports the fact that STNDBS at earlier stages of the disease is cost-effective in patients below the age of 61 when compared with the best medical treatment in the German health care system. This finding was supported by detailed sensitivity analyses reporting robust results. Whereas the EARLYSTIM study has shown STNDBS to be superior to medical therapy with respect to quality of life for patients with early motor complications, this further analysis has shown its cost-effectiveness.
Authors: Andrew Thach; Noam Kirson; Miriam L Zichlin; Ibrahima Dieye; Eric Pappert; G Rhys Williams Journal: J Health Econ Outcomes Res Date: 2021-11-17
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