title: Economic Analysis of Deep Brain Stimulation in Parkinson Disease: Systematic Review of the Literature.
abstract: BACKGROUND
  Parkinson disease (PD) is a chronic multifaceted neurodegenerative disorder of adult onset that affects quality of life and places a burden on patients, caregivers, and society. In early disease, dopaminergic therapy improves motor symptoms, but as the disease progresses, symptoms tend to increase in frequency and severity, even with best medical treatment (BMT). Deep brain stimulation (DBS) becomes an option for certain patients, but cost becomes an important issue.
  
  
  OBJECTIVE
  We performed a systematic review of the literature of economic studies of the use of DBS in patients with PD, including costs studies or economic evaluations expressed as cost per improvement in quality life, decrease in dose of pharmacological treatments, and the decrease of caregiver burden.
  
  
  METHODS
  We reviewed the following databases: Medline/PubMed, Embase, Cochrane Database of Systematic Reviews, LILACS, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform ICTRP portal and ClinicalTrials.gov from 1980 to 2015. Costs have been converted or adjusted to 2016 US dollars (US$).
  
  
  RESULTS
  Nine studies were identified. The average cost of DBS for a patient with PD in 5 years is US$186,244. The quality-adjusted life year was higher in DBS compared with BMT after at least 2 years of treatment, with an average incremental cost utility ratio of US$41,932 per additional quality-adjusted life year gained. Costs in the first year are higher with DBS because of direct costs related to the surgical procedure, the device, and the more frequent controls. Studies show better results with a longer time horizon (up to 5 years).
  
  
  CONCLUSIONS
  DBS is a cost-effective intervention for patients with advanced PD, but it has a high initial cost compared with BMT. However, DBS reduces pharmacologic treatment costs and should also reduce direct, indirect, and social costs of PD on the long term.
authors.affiliation: Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia.
authors.forename: Jaime Eduardo
authors.initials: JE
authors.lastname: Becerra
authors.affiliation: Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia.
authors.forename: Oscar
authors.initials: O
authors.lastname: Zorro
authors.affiliation: Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ruiz-Gaviria
authors.affiliation: NeuroEconomix, Bogota, Colombia.
authors.forename: Camilo
authors.initials: C
authors.lastname: Castañeda-Cardona
authors.affiliation: Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
authors.forename: Margarita
authors.initials: M
authors.lastname: Otálora-Esteban
authors.affiliation: Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
authors.forename: Sara
authors.initials: S
authors.lastname: Henao
authors.affiliation: Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
authors.forename: Sergio
authors.initials: S
authors.lastname: Navarrete
authors.affiliation: Neuroscience Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Acevedo
authors.affiliation: Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia. Electronic address: diego.rosselli@gmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Rosselli
mesh_terms: D000978:Antiparkinson Agents / Q000191:economics / Q000627:therapeutic use; D017028:Caregivers / Q000191:economics* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000191:economics / Q000706:statistics & numerical data; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D046690:Deep Brain Stimulation / Q000191:economics* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D010300:Parkinson Disease / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D015995:Prevalence; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents
keywords: Cost-effectiveness analysis; Deep brain stimulation; Economic analysis; Parkinson disease