Cost-effectiveness analysis of radiosurgical capsulotomy versus treatment as usual for treatment-resistant obsessive-compulsive disorder.

Autor:	Najera RA; 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas., Gregory ST; 2Magellan Health, Frisco, Texas., Shofty B; 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas., Anand A; 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas., Gadot R; 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas., Youngerman BE; 3Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York; and., Storch EA; 4Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas., Goodman WK; 4Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas., Sheth SA; 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2022 Jul 29; Vol. 138 (2), pp. 347-357. Date of Electronic Publication: 2022 Jul 29 (Print Publication: 2023).
DOI:	10.3171/2022.5.JNS22474
Abstrakt:	Objective: Stereotactic radiosurgical capsulotomy (SRS-C) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (TROCD). Unlike other procedures such as deep brain stimulation and radiofrequency ablation, the cost-effectiveness of SRS-C for TROCD has not been investigated. The authors herein report the first cost-effectiveness analysis of SRS-C for TROCD. Methods: Using a decision analytic model, the authors compared the cost-effectiveness of SRS-C to treatment as usual (TAU) for TROCD. Treatment response and complication rates were derived from a review of relevant clinical trials. Published algorithms were used to convert Yale-Brown Obsessive Compulsive Scale scores into utility scores reflecting improvements in quality of life. Costs were approached from the healthcare sector perspective and were drawn from Medicare reimbursement rates and available healthcare economics data. A Monte Carlo simulation and probabilistic sensitivity analysis were performed to estimate the incremental cost-effectiveness ratio. Results: One hundred fifty-eight TROCD patients across 9 studies who had undergone SRS-C and had at least 36 months of follow-up were included in the model. Compared to TAU, SRS-C was more cost-effective, with an estimated incremental cost-effectiveness ratio of $28,960 per quality-adjusted life year (QALY) gained. Within the 3-year time horizon, net QALYs gained were greater in the SRS-C group than the TAU group by 0.27 (95% CI 0.2698-0.2702, p < 0.0001). At willingness-to-pay thresholds of $50,000 and $100,000 per QALY, the Monte Carlo simulation revealed that SRS-C was more cost-effective than TAU in 83% and 100% of iterations, respectively. Conclusions: Compared to TAU, SRS-C for TROCD is more cost-effective under a range of possible cost and effectiveness values.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu