title: Cost-effectiveness of subthalmic nucleus deep brain stimulation for the treatment of advanced Parkinson disease in Hong Kong: a prospective study.
abstract: BACKGROUND
  Deep brain stimulation (DBS) is an effective but costly treatment for patients with advanced Parkinson disease (PD). This study examined the cost-effectiveness of DBS in relation to its improved effectiveness to help funding decision makers decide whether the treatment should be adopted. The incremental cost-effective ratio (ICER) per quality-adjusted life year has been benchmarked as being between US$50,000 and US$100,000 by US agencies, whereas it is less than €30,000 per quality-adjusted life year in Europe.
  
  
  OBJECTIVE
  To provide cost-effectiveness information of subthalamic nucleus DBS for patients with advanced PD.
  
  
  METHODS
  Direct medical expenses during the year before the DBS treatment were used to measure the baseline cost. Cost-effectiveness was measured by the ICER for the Unified Parkinson's Disease Rating Scale Part III and the ICER for the EuroQol Group's Health-Related Quality of Life measurement.
  
  
  RESULTS
  Thirteen patients with advanced PD were recruited between January 2009 and January 2011. A 1-point improvement in the Unified Parkinson's Disease Rating Scale Part III score was associated with an ICER of US$926 in the first year and US$421 in the second year. A 1-point improvement on the EuroQol Group's Health-Related Quality of Life measurement was associated with an ICER of US$123,110 in the first year and US$62,846 in the second year.
  
  
  CONCLUSIONS
  Cost-effectiveness of subthalamic nucleus DBS for treatment of advanced PD is greater during a 2-year period than 1 year only. These results can be used as a reference for the use of DBS for PD in a region with public health financing.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: X L
authors.initials: XL
authors.lastname: Zhu
authors.affiliation: Division of Neurosurgery, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Danny T M
authors.initials: DT
authors.lastname: Chan
authors.affiliation: Division of Neurosurgery, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Claire K Y
authors.initials: CK
authors.lastname: Lau
authors.affiliation: Division of Neurosurgery, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong. Electronic address: wpoon@surgery.cuhk.edu.hk.
authors.forename: Wai S
authors.initials: WS
authors.lastname: Poon
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Vincent C T
authors.initials: VC
authors.lastname: Mok
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Anne Y Y
authors.initials: AY
authors.lastname: Chan
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Lawrence K S
authors.initials: LK
authors.lastname: Wong
authors.affiliation: Division of Neurology, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Jonas H M
authors.initials: JH
authors.lastname: Yeung
authors.affiliation: Department of Economics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Michael C M
authors.initials: MC
authors.lastname: Leung
authors.affiliation: Division of Neurosurgery, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong Special Administrative Region, Hong Kong; Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Venus Y H
authors.initials: VY
authors.lastname: Tang
authors.affiliation: Department of Occupational Therapy, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Rosanna K M
authors.initials: RK
authors.lastname: Wong
authors.affiliation: Department of Finance, and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong.
authors.forename: Carol
authors.initials: C
authors.lastname: Yeung
mesh_terms: D000328:Adult; D000978:Antiparkinson Agents / Q000191:economics / Q000627:therapeutic use; D003363:Cost Control; D003362:Cost-Benefit Analysis; D046690:Deep Brain Stimulation / Q000191:economics*; D016527:Drug Costs; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010300:Parkinson Disease / Q000191:economics* / Q000628:therapy*; D018579:Patient Selection; D011300:Preoperative Care; D011446:Prospective Studies; D020531:Subthalamic Nucleus; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents
keywords: Cost-effectiveness; Deep brain stimulation; EQ5D; PD39; Parkinson disease; QALY; Quality of Life; Subthalamic nucleus; UPDRS