title: Internal Pulse Generators in Deep Brain Stimulation: Rechargeable or Not?
abstract: OBJECTIVE
  Deep brain stimulation (DBS) is a cost-effective strategy for the treatment of different neurologic disorders. However, DBS procedures are associated with high costs of implantation and replacement of the internal pulse generator (IPG). Different manufacturers propose the use of rechargeable IPGs. The objective of this study is to compare the implantation costs of nonrechargeable IPGs versus the estimated costs of rechargeable IPGs in different categories of patients to evaluate if an economic advantage for the health care system could be derived.
  
  
  METHODS
  The study looked at 149 patients who underwent a surgical procedure for IPG replacement. In a hypothetical scenario, rechargeable IPGs were implanted instead of nonrechargeable IPGs at the time of DBS system implantation. Another scenario was outlined in a perspective period of time, corresponding to the patients' life expectancy. Costs were calculated, and inferential analysis was performed.
  
  
  RESULTS
  A savings of €234,194, including the cost of management of complications, was calculated during a follow-up period of 7.9 years. In a comprehensive life expectancy period of 47 years, a savings of €5,918,188 would be obtained (P < 0.05). Long-term group data point out that a relevant savings would be expected from implantation of rechargeable IPGs in dystonic patients (P < 0.05) and patients with Parkinson disease (P < 0.05), and a savings is projected to occur in other categories of patients (P < 0.05).
  
  
  CONCLUSIONS
  Implantation of rechargeable IPGs presents clinical advantages compared with nonrechargeable devices. A huge economic savings can be realized with the implantation of rechargeable IPGs in categories of patients implanted with IPGs for DBS.
authors.affiliation: Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy. Electronic address: michele.rizzi@live.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Rizzi
authors.affiliation: Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Messina
authors.affiliation: Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Penner
authors.affiliation: Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Ammando
authors.affiliation: Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Muratorio
authors.affiliation: Department of Neurosurgery, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Franzini
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D046690:Deep Brain Stimulation / Q000191:economics / Q000295:instrumentation*; D020878:Device Removal / Q000191:economics; D004421:Dystonia / Q000191:economics / Q000628:therapy; D011211:Electric Power Supplies / Q000191:economics*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000191:economics / Q000601:surgery; D055815:Young Adult
keywords: Cost-effective analysis; Deep brain stimulation; Hardware-related complications; Internal pulse generator; Rechargeable battery