Pieter Ooms1, Matthijs Blankers2, Martijn Figee3, Isidoor O Bergfeld3, Pepijn van den Munckhof4, P Richard Schuurman4, Damiaan Denys5. 1. Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: p.ooms@amc.nl. 2. Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health Care, Amsterdam, The Netherlands; Trimbos Institute, Utrecht, The Netherlands. 3. Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands. 4. Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 5. Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands; Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Deep Brain Stimulation (DBS) is effective for obsessive-compulsive disorder (OCD), but requires expensive medical procedures. To date, no study has examined the cost-effectiveness of DBS for OCD. OBJECTIVE: To perform the first economic evaluation of DBS for therapy refractory OCD. METHODS: We conducted a 2-year prospective, open cost-effectiveness study, comparing DBS (n = 17) with treatment as usual (TAU) (n = 11), with cost per Quality-Adjusted-Life-Year (QALY) as outcome measure. Apart from the base-case, or primary analysis, we conducted two practice-based scenarios: (1) standard care scenario, without research and innovation costs, and (2) rechargeable scenario, in which we assume the use of a rechargeable battery. Base-case and both scenarios were extrapolated to four years to estimate long-term cost-effectiveness. RESULTS: Compared to TAU, DBS provides an additional 0.26 QALY (SD = 0.16). Median cost per QALY gained is estimated at €141,446 for base-case, €115,916 for standard care and €65,394 for the rechargeable scenario. Extending the time-horizon to four years results in a median cost per QALY of €80,313 for base-case, €69,287 for standard care, and turned out to be cost-saving at €4678 per QALY for the rechargeable scenario. Assuming a willingness to pay threshold of €80,000/QALY, DBS, under base-case and standard care had 25% and 35% probability of being more cost-effective than TAU. With the rechargeable scenario and in all scenarios extrapolated to four years, the probability of cost-effectiveness was equal or higher than TAU. CONCLUSIONS: This study indicates DBS for OCD is cost-effective in the long-term, especially when rechargeable batteries are taken into account.
BACKGROUND: Deep Brain Stimulation (DBS) is effective for obsessive-compulsive disorder (OCD), but requires expensive medical procedures. To date, no study has examined the cost-effectiveness of DBS for OCD. OBJECTIVE: To perform the first economic evaluation of DBS for therapy refractory OCD. METHODS: We conducted a 2-year prospective, open cost-effectiveness study, comparing DBS (n = 17) with treatment as usual (TAU) (n = 11), with cost per Quality-Adjusted-Life-Year (QALY) as outcome measure. Apart from the base-case, or primary analysis, we conducted two practice-based scenarios: (1) standard care scenario, without research and innovation costs, and (2) rechargeable scenario, in which we assume the use of a rechargeable battery. Base-case and both scenarios were extrapolated to four years to estimate long-term cost-effectiveness. RESULTS: Compared to TAU, DBS provides an additional 0.26 QALY (SD = 0.16). Median cost per QALY gained is estimated at €141,446 for base-case, €115,916 for standard care and €65,394 for the rechargeable scenario. Extending the time-horizon to four years results in a median cost per QALY of €80,313 for base-case, €69,287 for standard care, and turned out to be cost-saving at €4678 per QALY for the rechargeable scenario. Assuming a willingness to pay threshold of €80,000/QALY, DBS, under base-case and standard care had 25% and 35% probability of being more cost-effective than TAU. With the rechargeable scenario and in all scenarios extrapolated to four years, the probability of cost-effectiveness was equal or higher than TAU. CONCLUSIONS: This study indicates DBS for OCD is cost-effective in the long-term, especially when rechargeable batteries are taken into account.
Authors: Isidoor O Bergfeld; Eva Dijkstra; Ilse Graat; Pelle de Koning; Bastijn J G van den Boom; Tara Arbab; Nienke Vulink; Damiaan Denys; Ingo Willuhn; Roel J T Mocking Journal: Curr Top Behav Neurosci Date: 2021
Authors: Alexandra Kammen; Jonathon Cavaleri; Jordan Lam; Adam C Frank; Xenos Mason; Wooseong Choi; Marisa Penn; Kaevon Brasfield; Barbara Van Noppen; Stuart B Murray; Darrin Jason Lee Journal: Front Neurol Date: 2022-08-09 Impact factor: 4.086