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Review
. 2019 May 17;6(5):348-358.
doi: 10.1002/mdc3.12780. eCollection 2019 Jun.

Cost-Effectiveness of Deep Brain Stimulation With Movement Disorders: A Systematic Review

Tho Thi Hai Dang  1 , David Rowell  2 , Luke B Connelly  1   2   3
Affiliations
Review

Cost-Effectiveness of Deep Brain Stimulation With Movement Disorders: A Systematic Review

Tho Thi Hai Dang et al. Mov Disord Clin Pract. .

Abstract

Background: Movement disorders (MDs) are increasingly being managed with deep brain stimulation (DBS). High-quality economic evaluations (EEs) are necessary to evaluate the cost-effectiveness of DBS. We conducted a systematic review of published EEs of the treatment of MDs with DBS. The review compares and contrasts the reported incremental cost-effectiveness ratios (ICERs) and methodology employed by trial-based evaluations (TBEs) and model-based evaluations (MBEs).

Methods: MeSH and search terms relevant to "MDs," "DBS," and "EEs" were used to search biomedical and economics databases. Studies that used a comparative design to evaluate DBS, including before-after studies, were included. Quality and reporting assessments were conducted independently by 2 authors. Seventeen studies that targeted Parkinson's disease (PD), dystonia, and essential tremor (ET), met our selection criteria.

Results: Mean scores for methodological and reporting quality were 73% and 76%, respectively. The ICERs for DBS compared with best medical therapy to treat PD patients obtained from MBEs had a lower mean and range compared with those obtained from TBEs ($55,461-$735,192 per quality-adjusted life-year [QALY] vs. $9,301-$65,111 per QALY). Pre-post ICER for DBS to treat dystonia was $64,742 per QALY. DBS was not cost-effective in treating ET compared with focused-ultrasound surgery. Cost-effectiveness outcomes were sensitive to assumptions in health utilities, surgical costs, battery life-span, model time horizons, and the discount rate.

Conclusions: The infrequent use of randomized, controlled trials to evaluate DBS efficacy, the paucity of data reporting the long-term effectiveness and/or utility of DBS, and the uncertainty surrounding cost data limit our ability to report cost-effectiveness summaries that are robust.

Keywords: cost‐effectiveness; deep brain stimulation; economic evaluation; movement disorders; systematic review.

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Figures

Figure 1
Figure 1
PRISMA flowchart of study selection. DBS, deep brain stimulation; ICERs, incremental cost‐effectiveness ratios.
See this image and copyright information in PMC

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