title: Subthalamic Nucleus Deep Brain Stimulation May Reduce Medication Costs in Early Stage Parkinson's Disease.
abstract: BACKGROUND
  Subthalamic nucleus deep brain stimulation (STN-DBS) is well-known to reduce medication burden in advanced stage Parkinson's disease (PD). Preliminary data from a prospective, single blind, controlled pilot trial demonstrated that early stage PD subjects treated with STN-DBS also required less medication than those treated with optimal drug therapy (ODT).
  
  
  OBJECTIVE
  The purpose of this study was to analyze medication cost and utilization from the pilot trial of DBS in early stage PD and to project 10 year medication costs.
  
  
  METHODS
  Medication data collected at each visit were used to calculate medication costs. Medications were converted to levodopa equivalent daily dose, categorized by medication class, and compared. Medication costs were projected to advanced stage PD, the time when a typical patient may be offered DBS.
  
  
  RESULTS
  Medication costs increased 72% in the ODT group and decreased 16% in the DBS+ODT group from baseline to 24 months. This cost difference translates into a cumulative savings for the DBS+ODT group of $7,150 over the study period. Projected medication cost savings over 10 years reach $64,590. Additionally, DBS+ODT subjects were 80% less likely to require polypharmacy compared with ODT subjects at 24 months (p <  0.05; OR = 0.2; 95% CI: 0.04-0.97).
  
  
  CONCLUSIONS
  STN-DBS in early PD reduced medication cost over the two-year study period. DBS may offer substantial long-term reduction in medication cost by maintaining a simplified, low dose medication regimen. Further study is needed to confirm these findings, and the FDA has approved a pivotal, multicenter clinical trial evaluating STN-DBS in early PD.
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Mallory L
authors.initials: ML
authors.lastname: Hacker
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Currie
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Molinari
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Turchan
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Millan
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Heusinkveld
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Roach
authors.affiliation: Department of Neurosurgery, Vanderbilt University, Village at Vanderbilt, Nashville, TN, USA.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Konrad
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Davis
authors.affiliation: Department of Neurosurgery, Vanderbilt University, Village at Vanderbilt, Nashville, TN, USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Neimat
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Fenna T
authors.initials: FT
authors.lastname: Phibbs
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Hedera
authors.affiliation: Department of Biostatistics, Vanderbilt University, West End, Suite Nashville, TN, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Byrne
authors.affiliation: Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Charles
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000191:economics* / Q000627:therapeutic use*; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000191:economics* / Q000628:therapy*; D010865:Pilot Projects; D016037:Single-Blind Method; D020531:Subthalamic Nucleus / Q000502:physiology
chemical_list: D000978:Antiparkinson Agents
keywords: Parkinson’s disease; cost; cost analysis; deep brain stimulation; health economics; medication cost; subthalamic nucleus