title: Cost-effectiveness of neurostimulation in Parkinson's disease with early motor complications.
abstract: Recent research efforts have focused on the effects of deep brain stimulation of the subthalamic nucleus (STN DBS) for selected patients with mild-to-moderate PD experiencing motor complications.
  
  
  
  We assessed the cost utility of subthalamic DBS compared with the best medical treatment for German patients below the age of 61 with early motor complications of PD.
  
  
  
  We applied a previously published Markov model that integrated health utilities based on EuroQoL and direct costs over patients' lifetime adjusted to the German health care payer perspective (year of costing: 2013). Effectiveness was evaluated using the Parkinson's Disease Questionnaire 39 summary index. We performed sensitivity analyses to assess uncertainty.
  
  
  
  In the base-case analysis, the incremental cost-utility ratio for STN DBS compared to best medical treatment was 22,700 Euros per quality-adjusted life year gained. The time to, and costs for, battery exchange had a major effect on the incremental cost-utility ratios, but never exceeded a threshold of 50,000 Euros per quality-adjusted life year.
  
  
  
  Our decision analysis supports the fact that STN DBS at earlier stages of the disease is cost-effective in patients below the age of 61 when compared with the best medical treatment in the German health care system. This finding was supported by detailed sensitivity analyses reporting robust results. Whereas the EARLYSTIM study has shown STN DBS to be superior to medical therapy with respect to quality of life for patients with early motor complications, this further analysis has shown its cost-effectiveness. © 2016 International Parkinson and Movement Disorder Society.
authors: Department of Neurology, Philipps-University Marburg, Marburg, Germany.
authors: Judith
authors: J
authors: Dams
authors: Department of Neurology, Philipps-University Marburg, Marburg, Germany.
authors: Monika
authors: M
authors: Balzer-Geldsetzer
authors: Department of Public Health, Health Services Research and HealthTechnology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.|Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.|Department of Health Policy and Management, Harvard Chan School of Public Health, Boston, Massachusetts, USA.
authors: Uwe
authors: U
authors: Siebert
authors: Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany.
authors: Günther
authors: G
authors: Deuschl
authors: 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, and Movement Disorders Center, Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
authors: W M Michael
authors: WM
authors: Schuepbach
authors: Department of Neurology, University Hospital INSERM Unite 836, Grenoble Alpes University, Saint-Martin-d'Hères, France.
authors: Paul
authors: P
authors: Krack
authors: Department of Neurology, University Hospital Cologne, Cologne, Germany.
authors: Lars
authors: L
authors: Timmermann
authors: Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.
authors: Alfons
authors: A
authors: Schnitzler
authors: Department of Medical Sociology and Social Medicine, Philipps-University Marburg, Marburg, Germany.
authors: Jens-Peter
authors: JP
authors: Reese
authors: Department of Neurology, Philipps-University Marburg, Marburg, Germany.|Department of Geriatrics, University Duisburg-Essen, Essen, Germany.
authors: Richard
authors: R
authors: Dodel
mesh_terms: D000328:Adult; D000978:Antiparkinson Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D046690:Deep Brain Stimulation / Q000191:economics* / Q000379:methods; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications / Q000191:economics* / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D020531:Subthalamic Nucleus
chemical_list: D000978:Antiparkinson Agents
keywords: Markov model; cost-utility analysis; deep brain stimulation; dyskinesia; early Parkinson's disease