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Cost‐utility analysis of deep brain stimulation surgery plus best medical therapy versus best medical therapy in patients with Parkinson's: Economic evaluation alongside the PD SURG trial
Author(s) -
McIntosh Emma,
Gray Alastair,
Daniels Jane,
Gill Steven,
Ives Natalie,
Jenkinson Crispin,
Mitchell Rosalind,
Pall Hardev,
Patel Smitaa,
Quinn Niall,
Rick Caroline,
Wheatley Keith,
Williams Adrian
Publication year - 2016
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.26423
Subject(s) - medicine , quality of life (healthcare) , quality adjusted life year , confidence interval , randomization , randomized controlled trial , cost effectiveness , deep brain stimulation , physical therapy , surgery , parkinson's disease , disease , risk analysis (engineering) , nursing
Williams and colleagues reported that DBS surgery for patients with advanced PD improves motor function and quality of life compared to best medical therapy alone at 1 year, but with surgery‐related side effects in a minority. This article reports on the economic evaluation alongside this trial. Methods Detailed resource use and quality of life over 12 months after randomization was obtained from the trial reported by Williams and colleagues. Outcomes were measured using the EQ‐5D and quality‐adjusted life years calculated. Results Year 1 costs for surgery were significantly higher than in best medical therapy, at £19,069 compared to £9,813, a difference of £9,256 (95% confidence interval [CI]: £7,625, £10,887). There was a small, significant gain in utility at 1 year but a statistically insignificant gain of 0.02 quality‐adjusted life years (95% CI: −0.015, 0.05) in the surgical arm. The incremental cost per quality‐adjusted life year of surgery at 1 year was £468,528. Extrapolation reveals that after 5 years, this ratio is likely to reduce to £45,180, but subsequently rise to £70,537 at 10 years owing to the increased probability of battery replacements (and re‐replacements) beyond 5 years. Conclusion In this patient group, DBS is not cost‐effective at 1 year. Extrapolation, however, reveals an increasing likelihood of cost‐effectiveness up to 5 years and reducing cost‐effectiveness between 5 and 10 years. These models are sensitive to assumptions about future costs and quality‐adjusted life years gained. © 2016 International Parkinson and Movement Disorder Society