1. Cost-utility analysis of deep brain stimulation surgery plus best medical therapy versus best medical therapy in patients with Parkinson's: Economic evaluation alongside the PD SURG trial.
- Author
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McIntosh E, Gray A, Daniels J, Gill S, Ives N, Jenkinson C, Mitchell R, Pall H, Patel S, Quinn N, Rick C, Wheatley K, and Williams A
- Subjects
- Antiparkinson Agents therapeutic use, Deep Brain Stimulation adverse effects, Drug Therapy, Combination, Follow-Up Studies, Humans, Parkinson Disease drug therapy, Parkinson Disease surgery, Antiparkinson Agents economics, Cost-Benefit Analysis, Deep Brain Stimulation economics, Outcome Assessment, Health Care, Parkinson Disease economics, Parkinson Disease therapy
- Abstract
Introduction: Williams and colleagues reported that DBS surgery for patients with advanced PD improves motor function and quality of life compared to best medical therapy alone at 1 year, but with surgery-related side effects in a minority. This article reports on the economic evaluation alongside this trial., Methods: Detailed resource use and quality of life over 12 months after randomization was obtained from the trial reported by Williams and colleagues. Outcomes were measured using the EQ-5D and quality-adjusted life years calculated., Results: Year 1 costs for surgery were significantly higher than in best medical therapy, at £19,069 compared to £9,813, a difference of £9,256 (95% confidence interval [CI]: £7,625, £10,887). There was a small, significant gain in utility at 1 year but a statistically insignificant gain of 0.02 quality-adjusted life years (95% CI: -0.015, 0.05) in the surgical arm. The incremental cost per quality-adjusted life year of surgery at 1 year was £468,528. Extrapolation reveals that after 5 years, this ratio is likely to reduce to £45,180, but subsequently rise to £70,537 at 10 years owing to the increased probability of battery replacements (and re-replacements) beyond 5 years., Conclusion: In this patient group, DBS is not cost-effective at 1 year. Extrapolation, however, reveals an increasing likelihood of cost-effectiveness up to 5 years and reducing cost-effectiveness between 5 and 10 years. These models are sensitive to assumptions about future costs and quality-adjusted life years gained. © 2016 International Parkinson and Movement Disorder Society., (© 2016 International Parkinson and Movement Disorder Society.)
- Published
- 2016
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