Bilateral Deep Brain Stimulation is the Procedure to Beat for Advanced Parkinson Disease: A Meta-Analytic, Cost-Effective Threshold Analysis for Focused Ultrasound
| Autor: | Disep I. Ojukwu, Uma V Mahajan, Sherman C. Stein, Joshua M. Rosenow, Seul Ku, Camilla Kilbane, Pejman Ghanouni, Casey H. Halpern, Kevin K. Kumar, Vinod K Ravikumar |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Deep brain stimulation Cost effectiveness Radiofrequency ablation Cost-Benefit Analysis Deep Brain Stimulation medicine.medical_treatment Unified Parkinson's disease rating scale Globus Pallidus Medicare law.invention 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation Subthalamic Nucleus law Humans Medicine Adverse effect Ultrasonography Interventional Aged 030304 developmental biology 0303 health sciences medicine.diagnostic_test business.industry Parkinson Disease Magnetic resonance imaging Middle Aged Ablation Magnetic Resonance Imaging United States Subthalamic nucleus Treatment Outcome Research—Human—Clinical Studies Female Surgery Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgery |
| ISSN: | 1524-4040 0148-396X |
| DOI: | 10.1093/neuros/nyaa485 |
| Popis: | Background Parkinson disease (PD) impairs daily functioning for an increasing number of patients and has a growing national economic burden. Deep brain stimulation (DBS) may be the most broadly accepted procedural intervention for PD, but cost-effectiveness has not been established. Moreover, magnetic resonance image-guided focused ultrasound (FUS) is an emerging incisionless, ablative treatment that could potentially be safer and even more cost-effective. Objective To (1) quantify the utility (functional disability metric) imparted by DBS and radiofrequency ablation (RF), (2) compare cost-effectiveness of DBS and RF, and (3) establish a preliminary success threshold at which FUS would be cost-effective compared to these procedures. Methods We performed a meta-analysis of articles (1998-2018) of DBS and RF targeting the globus pallidus or subthalamic nucleus in PD patients and calculated utility using pooled Unified Parkinson Disease Rating Scale motor (UPDRS-3) scores and adverse events incidences. We calculated Medicare reimbursements for each treatment as a proxy for societal cost. Results Over a 22-mo mean follow-up period, bilateral DBS imparted the most utility (0.423 quality-adjusted life-years added) compared to (in order of best to worst) bilateral RF, unilateral DBS, and unilateral RF, and was the most cost-effective (expected cost: $32 095 ± $594) over a 22-mo mean follow-up. Based on this benchmark, FUS would need to impart UPDRS-3 reductions of ∼16% and ∼33% to be the most cost-effective treatment over 2- and 5-yr periods, respectively. Conclusion Bilateral DBS imparts the most utility and cost-effectiveness for PD. If our established success threshold is met, FUS ablation could dominate bilateral DBS's cost-effectiveness from a societal cost perspective. |
| Databáze: | OpenAIRE |
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