It has been established that deep brain stimulation is clinically superior to medical therapy for treating advanced Parkinson’s disease. Jan B Pietzsch (Department of Management Science and Engineering, Stanford University, Stanford, USA) and others studied the cost-effectiveness of deep brain stimulation in conjunction with medical therapy compared to best medical therapy alone, using the latest clinical and cost data for the US healthcare system. The study was published in the journal Neuromodulation.
The investigators used a decision-analytic state-transition (Markov) model to project Parkinson’s disease progression and associated costs for the two treatment strategies. They estimated the discounted incremental cost-effectiveness ratio in US dollars per quality-adjusted life-year (QALY) from the Medicare payer perspective, considering a ten-year horizon, and evaluated the robustness of their projections through extensive deterministic sensitivity analyses.
“Over ten years, deep brain stimulation treatment led to discounted total costs of US$130,510 compared to US$91,026 for best medical therapy and added 1.69 QALYs more than best medical therapy, resulting in an ICER of US$23,404 per QALY. This incremental cost-effectiveness ratio was relatively insensitive to variations in input parameters, with neurostimulator replacement, costs for deep brain stimulation implantation, and costs for treatment of disease-related falls having the greatest effects. Across all investigated scenarios, including a five-year horizon, incremental cost-effectiveness ratio remained under US$50,000 per QALY. Longer follow-up periods and younger treatment age were associated with greater cost-effectiveness,” the authors report.
Finally, the Cost-Effectiveness of Deep Brain Stimulation for Advanced Parkinson’s Disease in the United States study findings maintain that deep brain stimulation “is a cost-effective treatment strategy for advanced Parkinson’s disease in the US healthcare system across a wide range of assumptions. Deep brain stimulation yields substantial improvements in health-related quality of life at a value profile that compares favourably to other well-accepted therapies.”