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Deep brain stimulation in the treatment of Parkinson’s disease

A cost-effectiveness analysis

From the Departments of Community and Preventive Medicine (Dr. Holloway and K. Tomaszewski) and Neurology (Dr. Holloway), University of Rochester School of Medicine, NY.

Address correspondence and reprint requests to K.J. Tomaszewski, Department of Community and Preventive Medicine, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 644, Rochester, NY 14642; e-mail: kenneth_tomaszewski{at}urmc.rochester.edu

Background:— In treating PD, deep brain stimulation (DBS) has shown great promise in a series of uncontrolled studies.

Objective:— To estimate the incremental cost effectiveness of DBS compared with the best medical management in late-stage PD.

Methods:— The authors constructed a decision model to determine the lifetime incremental cost effectiveness between two options in patients with PD aged 50 years and older: 1) best medical management and 2) DBS. As the long-term efficacy of DBS (>3 years) is not known, key assumptions regarding the procedure’s long-term durability were made. Costs were in US 2000 dollars, and quality-adjusted life year (QALY) was the effectiveness measure. Base assumptions were that quality of life (QOL) in patients with late-stage PD is 0.55 (0-to-1 scale, 1 is perfect health) and that DBS benefits are constant for 4 years, eroding gradually over the next 5 years until at parity with those produced by best medical management. Incremental cost-effectiveness and sensitivity analyses were performed.

Results:— Under base-case assumptions, DBS provides an additional 0.72 QALY at an additional cost of $35,000 compared with best medical management that results in an incremental cost-effectiveness ratio (C/E) of $49,000. QOL increases of between 18 and 30% resulted in questionable cost effectiveness. QOL increases of between 6 and 18% resulted in incremental C/E ratios not usually considered cost effective (>100,000/QALY).

Conclusions:— The results suggest that DBS may be cost effective in treating PD if QOL improves 18% or more compared with those receiving best medical management. This underscores the need for randomized, controlled, prospective DBS experiments including QOL and economic components.

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