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Cost‐effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor
Author(s) -
Ravikumar Vinod K.,
Parker Jonathon J.,
Hornbeck Traci S.,
Santini Veronica E.,
Pauly Kim Butts,
Wintermark Max,
Ghanouni Pejman,
Stein Sherman C.,
Halpern Casey H.
Publication year - 2017
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.26997
Subject(s) - thalamotomy , radiosurgery , medicine , magnetic resonance imaging , essential tremor , reimbursement , ultrasound , cost effectiveness , focused ultrasound , radiology , physical medicine and rehabilitation , parkinson's disease , deep brain stimulation , radiation therapy , disease , health care , risk analysis (engineering) , economics , economic growth
Abstract Background Essential tremor remains a very common yet medically refractory condition. A recent phase 3 study demonstrated that magnetic resonance‐guided focused ultrasound thalamotomy significantly improved upper limb tremor. The objectives of this study were to assess this novel therapy's cost‐effectiveness compared with existing procedural options. Methods Literature searches of magnetic resonance‐guided focused ultrasound thalamotomy, DBS, and stereotactic radiosurgery for essential tremor were performed. Pre‐ and postoperative tremor‐related disability scores were collected from 32 studies involving 83 magnetic resonance‐guided focused ultrasound thalamotomies, 615 DBSs, and 260 stereotactic radiosurgery cases. Utility, defined as quality of life and derived from percent change in functional disability, was calculated; Medicare reimbursement was employed as a proxy for societal cost. Medicare reimbursement rates are not established for magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor; therefore, reimbursements were estimated to be approximately equivalent to stereotactic radiosurgery to assess a cost threshold. A decision analysis model was constructed to examine the most cost‐effective option for essential tremor, implementing meta‐analytic techniques. Results Magnetic resonance‐guided focused ultrasound thalamotomy resulted in significantly higher utility scores compared with DBS ( P < 0.001) or stereotactic radiosurgery ( P < 0.001). Projected costs of magnetic resonance‐guided focused ultrasound thalamotomy were significantly less than DBS ( P < 0.001), but not significantly different from radiosurgery. Conclusions Magnetic resonance‐guided focused ultrasound thalamotomy is cost‐effective for tremor compared with DBS and stereotactic radiosurgery and more effective than both. Even if longer follow‐up finds changes in effectiveness or costs, focused ultrasound thalamotomy will likely remain competitive with both alternatives. © 2017 International Parkinson and Movement Disorder Society