title: Cost-Effectiveness of Deep Brain Stimulation for Advanced Parkinson's Disease in the United States.
abstract: OBJECTIVE
  Deep brain stimulation (DBS), which uses an implantable device to modulate brain activity, is clinically superior to medical therapy for treating advanced Parkinson's disease (PD). We studied the cost-effectiveness of DBS in conjunction with medical therapy compared to best medical therapy (BMT) alone, using the latest clinical and cost data for the U.S. healthcare system.
  
  
  METHODS
  We used a decision-analytic state-transition (Markov) model to project PD progression and associated costs for the two treatment strategies. We estimated the discounted incremental cost-effectiveness ratio (ICER) in U.S. dollars per quality-adjusted life-year (QALY) from the Medicare payer perspective, considering a ten-year horizon, and evaluated the robustness of our projections through extensive deterministic sensitivity analyses.
  
  
  RESULTS
  Over ten years, DBS treatment led to discounted total costs of $130,510 compared to $91,026 for BMT and added 1.69 QALYs more than BMT, resulting in an ICER of $23,404 per QALY. This ICER was relatively insensitive to variations in input parameters, with neurostimulator replacement, costs for DBS implantation, and costs for treatment of disease-related falls having the greatest effects. Across all investigated scenarios, including a five-year horizon, ICERs remained under $50,000 per QALY. Longer follow-up periods and younger treatment age were associated with greater cost-effectiveness.
  
  
  CONCLUSIONS
  DBS is a cost-effective treatment strategy for advanced PD in the U.S. healthcare system across a wide range of assumptions. DBS yields substantial improvements in health-related quality of life at a value profile that compares favorably to other well-accepted therapies.
authors: Wing Tech Inc., Menlo Park, CA, USA.|Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
authors: Jan B
authors: JB
authors: Pietzsch
authors: Wing Tech Inc., Menlo Park, CA, USA.
authors: Abigail M
authors: AM
authors: Garner
authors: Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA. William.Marks@ucsf.edu.
authors: William J
authors: WJ
authors: Marks
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D046690:Deep Brain Stimulation / Q000191:economics* / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010300:Parkinson Disease / Q000191:economics / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States
chemical_list: D000978:Antiparkinson Agents
keywords: Cost-effectiveness; Parkinson's disease; deep brain stimulation