title: Deep Brain Stimulation for Parkinson's Disease with Early Motor Complications: A UK Cost-Effectiveness Analysis.
abstract: BACKGROUND
  Parkinson's disease (PD) is a debilitating illness associated with considerable impairment of quality of life and substantial costs to health care systems. Deep brain stimulation (DBS) is an established surgical treatment option for some patients with advanced PD. The EARLYSTIM trial has recently demonstrated its clinical benefit also in patients with early motor complications. We sought to evaluate the cost-effectiveness of DBS, compared to best medical therapy (BMT), among PD patients with early onset of motor complications, from a United Kingdom (UK) payer perspective.
  
  
  METHODS
  We developed a Markov model to represent the progression of PD as rated using the Unified Parkinson's Disease Rating Scale (UPDRS) over time in patients with early PD. Evidence sources were a systematic review of clinical evidence; data from the EARLYSTIM study; and a UK Clinical Practice Research Datalink (CPRD) dataset including DBS patients. A mapping algorithm was developed to generate utility values based on UPDRS data for each intervention. The cost-effectiveness was expressed as the incremental cost per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were undertaken to explore the effect of parameter uncertainty.
  
  
  RESULTS
  Over a 15-year time horizon, DBS was predicted to lead to additional mean cost per patient of £26,799 compared with BMT (£73,077/patient versus £46,278/patient) and an additional mean 1.35 QALYs (6.69 QALYs versus 5.35 QALYs), resulting in an incremental cost-effectiveness ratio of £19,887 per QALY gained with a 99% probability of DBS being cost-effective at a threshold of £30,000/QALY. One-way sensitivity analyses suggested that the results were not significantly impacted by plausible changes in the input parameter values.
  
  
  CONCLUSIONS
  These results indicate that DBS is a cost-effective intervention in PD patients with early motor complications when compared with existing interventions, offering additional health benefits at acceptable incremental cost. This supports the extended use of DBS among patients with early onset of motor complications.
authors.affiliation: HTA Consulting, Krakow, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Fundament
authors.affiliation: The Walton Centre NHS Foundation Trust and Liverpool University, Liverpool, United Kingdom.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Eldridge
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Green
authors.affiliation: Bristol Brain Centre, Southmead Hospital, Bristol, United Kingdom.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Whone
authors.affiliation: University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Williams
authors.affiliation: Movement Disorders Center, Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.|Assistance Publique Hôpitaux de Paris, Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière, Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France.
authors.forename: W M Michael
authors.initials: WM
authors.lastname: Schuepbach
mesh_terms: D003362:Cost-Benefit Analysis; D046690:Deep Brain Stimulation / Q000191:economics* / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D009043:Motor Activity; D010300:Parkinson Disease / Q000191:economics* / Q000503:physiopathology / Q000628:therapy*; D011336:Probability; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D006113:United Kingdom