title: Parkinson's disease medication use and costs following deep brain stimulation.
abstract: The costs of treating Parkinson's disease (PD) are significant. Medication reductions usually occur following deep brain stimulation (DBS), but less is known about the relative costs of DBS targets, the globus pallidum (GPi) or the subthalamic nucleus (STN). This article reports medication costs between best medical therapy (BMT) and DBS over 6 months postintervention and by DBS target over 36 months postsurgery. Prescription use and costs for patients (n = 161) with advanced PD from a multisite randomized trial of BMT and DBS were examined overall and by drug category. Medication adjustment occurred at the discretion of the neurologists. PD medications were extracted from the Department of Veterans Affairs Decision Support System database. Levodopa equivalents (LEDD) were significantly lower for DBS than for BMT patients at 6 months (1101 vs 1398 mg; P = .005), but costs were similar (US$1750 vs US$1589; P = .55). LEDD decreased following GPi and STN DBS (1395-1161 mg, P = .014; and 1347-891 mg, P < .0001, respectively) in the first 6 months, but was lower for STN than for GPi over 36 months following DBS (P = .03). Total PD medication costs per 6-month intervals decreased over 36 months (P < .0001), but did not differ by target (P = .50) in the mixed-model analysis. However, cumulative medication costs over 36 months were lower for the STN than for GPi patients. PD medication use and costs decreased following DBS in either target over 36 months, but cumulative costs were less for STN than for GPi.
authors.affiliation: Hines VA Hospital, Center for Management of Complex Chronic Care, Hines, Illinois 60141, USA. Frances.Weaver@va.gov
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
authors.forename: Lishan
authors.initials: L
authors.lastname: Cao
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holloway
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Vickrey
authors.forename: Tanya
authors.initials: T
authors.lastname: Simuni
authors.forename: Ann
authors.initials: A
authors.lastname: Hendricks
authors.forename: Dolores
authors.initials: D
authors.lastname: Ippolito
mesh_terms: D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000191:economics* / Q000379:methods; D005260:Female; D005917:Globus Pallidus / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000191:economics* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D020531:Subthalamic Nucleus / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D014728:Veterans
chemical_list: D014150:Antipsychotic Agents