[Review of the economic evidence on the use of deep brain stimulation in late stage Parkinson's disease].
BACKGROUND
The purpose of this article is to present the results of a systematic review on the costs and the efficiency of Deep Brain Stimulation (DBS) on patients suffering advanced Parkinson's disease.


METHODS
A systematic review is performed using databases such as Medline, NHS EED and HTA del Centre for Reviews and Dissemination and Google Scholar from January 2001-2008.


RESULTS
Ten articles meet the criteria; one cost description, four cost analyses and five economic evaluations. The scientific evidence shows a reduction in the pharmaceutical costs of those patients treated with DBS. Regarding the direct medical costs, the same statement cannot be made. While some studies estimate the equivalent annual cost of DBS is 54,7% higher than that of traditional therapy, other studies, which include indirect costs such as productivity losses or informal care, claim DBS costs 34,7% less. The incremental cost-effectiveness ratio per QALY is slightly above euro30.000 in 1998 in both the cost-utility analyses where the time horizon was 5 years or more. In the third cost-utility analysis, DBS is the dominant option when the equivalent annual cost was computed.


CONCLUSIONS
The available evidence is not strong enough to conclude whether DBS' direct medical costs are higher or lower than the costs of traditional therapy. Key words: Parkinson's disease. Deep brain stimulation. Subthalamic stimulation. Cost analysis. Economic evaluation.
Puig-Junoy
J
J
Centro de Investigación en Economia y Salud (CRES-UPF) Universitat Pompeu Fabra, Barcelona. jaume.puig@upf.edu
Puig Peiró
R
R
D000978:Antiparkinson Agents / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D046690:Deep Brain Stimulation / Q000191:economics*; D006801:Humans; D010300:Parkinson Disease / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D013030:Spain
D000978:Antiparkinson Agents