title: Rechargeable or Nonrechargeable Deep Brain Stimulation in Dystonia: A Cost Analysis.
abstract: OBJECTIVE
  Deep brain stimulation of the internal Globus Pallidus (GPi DBS) delivered by an implantable neurostimulator (INS) is an established, effective, and safe treatment option for patients with medically refractory primary dystonia. Compared to other DBS targets, the battery life of the INS is substantially shorter due to the higher energy demands required to penetrate the GPi resulting in faster battery depletion and more frequent hospitalizations for INS replacement. We, therefore, performed a cost analysis to compare a rechargeable DBS system, Activa®RC, with nonrechargeable systems, from the perspective of the French public health insurer.
  
  
  METHODS
  To estimate the cost of INS replacement in the nonrechargeable cohort, and costs potentially avoided in the hypothetical Activa®RC cohort, the medical records of patients who had undergone GPi DBS with a nonrechargeable INS between 1996 and 2010 at a center in France were accessed. Replacement rates were estimated for up to nine years.
  
  
  RESULTS
  With Activa®RC, a total of 315 hospitalizations for replacement procedures would have been avoided over nine years compared with a nonrechargeable INS, resulting in a discounted mean direct medical cost per patient over nine years of €50,119 with a nonrechargeable INS and €33,306 with Activa®RC, a reduction of 34%.
  
  
  CONCLUSIONS
  The adoption of a rechargeable instead of a nonrechargeable INS for eligible patients with dystonia may provide substantial savings to the public health insurer in France.
authors.affiliation: Unité de Recherche sur les Comportements et Mouvements Anormaux, CHU Montpellier, France.|Université de Montpellier, France.|Institut de Génomique Fonctionnelle, Montpellier, France.|CNRS UMR5203, Montpellier, France.|INSERM U661, Montpellier, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Perez
authors.affiliation: Unité de Recherche sur les Comportements et Mouvements Anormaux, CHU Montpellier, France.|Université de Montpellier, France.|Institut de Génomique Fonctionnelle, Montpellier, France.|CNRS UMR5203, Montpellier, France.|INSERM U661, Montpellier, France.|Unité Médico-Chirurgicale de Neurochirurgie Fonctionnelle et Stéréotaxique, CHU Montpellier, France.
authors.forename: Victoria
authors.initials: V
authors.lastname: Gonzalez
authors.affiliation: Unité de Recherche sur les Comportements et Mouvements Anormaux, CHU Montpellier, France.|Université de Montpellier, France.|Institut de Génomique Fonctionnelle, Montpellier, France.|CNRS UMR5203, Montpellier, France.|INSERM U661, Montpellier, France.|Unité Médico-Chirurgicale de Neurochirurgie Fonctionnelle et Stéréotaxique, CHU Montpellier, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Cif
authors.affiliation: Unité de Recherche sur les Comportements et Mouvements Anormaux, CHU Montpellier, France.|Université de Montpellier, France.|Institut de Génomique Fonctionnelle, Montpellier, France.|CNRS UMR5203, Montpellier, France.|INSERM U661, Montpellier, France.|Unité Médico-Chirurgicale de Neurochirurgie Fonctionnelle et Stéréotaxique, CHU Montpellier, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Cyprien
authors.affiliation: Unité de Recherche sur les Comportements et Mouvements Anormaux, CHU Montpellier, France.|Université de Montpellier, France.|Institut de Génomique Fonctionnelle, Montpellier, France.|CNRS UMR5203, Montpellier, France.|INSERM U661, Montpellier, France.|Unité Médico-Chirurgicale de Neurochirurgie Fonctionnelle et Stéréotaxique, CHU Montpellier, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Chan-Seng
authors.affiliation: Unité de Recherche sur les Comportements et Mouvements Anormaux, CHU Montpellier, France.|Université de Montpellier, France.|Institut de Génomique Fonctionnelle, Montpellier, France.|CNRS UMR5203, Montpellier, France.|INSERM U661, Montpellier, France.|Unité Médico-Chirurgicale de Neurochirurgie Fonctionnelle et Stéréotaxique, CHU Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Coubes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003365:Costs and Cost Analysis; D046690:Deep Brain Stimulation / Q000191:economics / Q000295:instrumentation / Q000379:methods; D020821:Dystonic Disorders / Q000191:economics / Q000628:therapy*; D011211:Electric Power Supplies / Q000191:economics*; D004567:Electrodes, Implanted; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Costs and cost analysis; deep brain stimulation; dystonia