title: Cost-Effectiveness Analysis of Deep Brain Stimulation in Patients with Parkinson's Disease in Japan.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) is an effective surgical option for treating Parkinson's disease (PD). DBS is invasive, with a high initial cost. In Japan, questions have been raised about its cost-effectiveness and the resulting improvements in outcome. The aim of this study was to evaluate the cost-effectiveness of DBS for PD in Japan, particularly whether early or late DBS is more cost-effective.
  
  
  METHODS
  We used a Markov cohort simulation to follow the clinical course of DBS for PD. We conducted a survey to capture QOL scores among healthy Japanese volunteers. Transition probabilities were estimated from randomized clinical trials. We determined direct medical costs from the perspective of the Japanese health care system. Outcomes were assessed as quality-adjusted life years. We conducted univariate and probabilistic sensitivity analyses.
  
  
  RESULTS
  DBS costs an additional 10.3 million Japanese yen (US$85,100; exchange rate on October 28, 2015 was 121 yen to $1) for a gain of 3.2 quality-adjusted life years. The incremental cost-effectiveness ratio was 3.1 million yen ($25,600). The incremental cost-effectiveness ratio was 8.5 million yen ($70,200) for early DBS, 3.1 million yen ($25,600) for intermediate DBS, and 3.3 million yen ($27,200) for late-stage DBS.
  
  
  CONCLUSIONS
  Our model suggests that DBS is cost-effective in the Japanese health care system. DBS is more cost-effective if performed in the intermediate rather than early or late stages of PD.
authors.affiliation: Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Japan. Electronic address: keith.kawamoto@toki.waseda.jp.
authors.forename: Yukiyoshi
authors.initials: Y
authors.lastname: Kawamoto
authors.affiliation: Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Japan; Global Health Research Coordinating Center, Kanagawa Academy of Science and Technology, Japan.
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Mouri
authors.affiliation: Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Japan.
authors.forename: Takaomi
authors.initials: T
authors.lastname: Taira
authors.affiliation: Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iseki
authors.affiliation: Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Masamune
mesh_terms: D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods*; D046690:Deep Brain Stimulation / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010300:Parkinson Disease / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D011336:Probability; D011788:Quality of Life / Q000523:psychology
keywords: Cost-effectiveness; Deep brain stimulation; Markov model; Parkinsonʼs disease; QOL scores; Quality-adjusted life-year