title: Cost-utility analysis of deep brain stimulation surgery plus best medical therapy versus best medical therapy in patients with Parkinson's: Economic evaluation alongside the PD SURG trial.
abstract: Williams and colleagues reported that DBS surgery for patients with advanced PD improves motor function and quality of life compared to best medical therapy alone at 1 year, but with surgery-related side effects in a minority. This article reports on the economic evaluation alongside this trial.
  
  
  
  Detailed resource use and quality of life over 12 months after randomization was obtained from the trial reported by Williams and colleagues. Outcomes were measured using the EQ-5D and quality-adjusted life years calculated.
  
  
  
  Year 1 costs for surgery were significantly higher than in best medical therapy, at £19,069 compared to £9,813, a difference of £9,256 (95% confidence interval [CI]: £7,625, £10,887). There was a small, significant gain in utility at 1 year but a statistically insignificant gain of 0.02 quality-adjusted life years (95% CI: -0.015, 0.05) in the surgical arm. The incremental cost per quality-adjusted life year of surgery at 1 year was £468,528. Extrapolation reveals that after 5 years, this ratio is likely to reduce to £45,180, but subsequently rise to £70,537 at 10 years owing to the increased probability of battery replacements (and re-replacements) beyond 5 years.
  
  
  
  In this patient group, DBS is not cost-effective at 1 year. Extrapolation, however, reveals an increasing likelihood of cost-effectiveness up to 5 years and reducing cost-effectiveness between 5 and 10 years. These models are sensitive to assumptions about future costs and quality-adjusted life years gained. © 2016 International Parkinson and Movement Disorder Society.
authors: Health Economics and Health Technology Assessment, University of Glasgow, Institute of Health and Wellbeing, Glasgow, United Kingdom.
authors: Emma
authors: E
authors: McIntosh
authors: Health Economics Research Centre, University of Oxford, Oxford, United Kingdom.
authors: Alastair
authors: A
authors: Gray
authors: Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom.
authors: Jane
authors: J
authors: Daniels
authors: Frenchay Hospital, Bristol, United Kingdom.
authors: Steven
authors: S
authors: Gill
authors: Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom.
authors: Natalie
authors: N
authors: Ives
authors: Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK.
authors: Crispin
authors: C
authors: Jenkinson
authors: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors: Rosalind
authors: R
authors: Mitchell
authors: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors: Hardev
authors: H
authors: Pall
authors: Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom.
authors: Smitaa
authors: S
authors: Patel
authors: UCL Institute of Neurology, London, United Kingdom.
authors: Niall
authors: N
authors: Quinn
authors: Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom.
authors: Caroline
authors: C
authors: Rick
authors: Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic SciencesCollege of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
authors: Keith
authors: K
authors: Wheatley
authors: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors: Adrian
authors: A
authors: Williams
mesh_terms: D000978:Antiparkinson Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000191:economics*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy*
chemical_list: D000978:Antiparkinson Agents
keywords: PD SURG; Parkinson's; deep brain stimulation; economic evaluation