Abstract
ObjectiveTo investigate the cost differences between magnetic resonance-guided focussed ultrasound (MRgFUS) and unilateral deep brain stimulation (DBS) for the treatment of medication-refractory essential tremor (ET) in Japan using a cost-minimisation model.MethodsA cost-minimisation model estimated total costs for MRgFUS and unilateral DBS by summing the pre-procedure, procedure, and post-procedure costs over a 12-month time horizon, using data from published sources and expert clinical opinion. The model base case considered medical costs from fee-for-service tariffs. Scenario analyses investigated the use of Diagnosis Procedure Combination tariffs, a diagnosis-related group-based fixed-payment system, and the addition of healthcare professional labour costs healthcare professionals using tariffs from the Japanese Health Insurance Federation for Surgery. One-way sensitivity analyses altered costs associated with tremor recurrence after MRgFUS, the extraction rate following unilateral DBS, the length of hospitalisation for unilateral DBS and the procedure duration for MRgFUS. The impact of uncertainty in model parameters on the model results was further explored using probabilistic sensitivity analysis.ResultsCompared to unilateral DBS, MRgFUS was cost saving in the base case and Diagnosis Procedure Combination cost scenario, with total savings of JPY400,380 and JPY414,691, respectively. The majority of savings were accrued at the procedural stage. Including labour costs further increased the cost differences between MRgFUS and unilateral DBS. Cost savings were maintained in each sensitivity analysis and the probabilistic sensitivity analysis, demonstrating that the model results are highly robust.ConclusionsIn the Japanese healthcare setting, MRgFUS could be a cost saving option versus unilateral DBS for treating medication-refractory ET. The model results may even be conservative, as the cost of multiple follow-ups for unilateral DBS and treatment costs for adverse events associated with each procedure were not included. This model is also consistent with the results of other economic analyses of MRgFUS versus DBS in various settings worldwide.
Highlights
Essential tremor (ET) is the most dominant form of movement disorder worldwide, with a prevalence of 4.6% in individuals aged 65 years [1]
INSIGHTEC Ltd to perform this study and Costello Medical Consulting Ltd were further contracted for medical writing and editorial support
Lance Richard, an employee of INSIGHTEC Ltd, was involved in the decision to publish this manuscript, manuscript preparation and study design, but had no influence on the data collection and analysis involved in generating model results
Summary
Essential tremor (ET) is the most dominant form of movement disorder worldwide, with a prevalence of 4.6% in individuals aged 65 years [1]. While many patients respond well to first-line oral medications and achieve a reduction in tremulous symptoms, approximately 30–50% of ET patients are medication-refractory [6, 7]. This leaves a substantial proportion suffering from poor dexterity and a diminished HRQoL [4, 8]. DBS is commonly performed, and MRgFUS is available in many hospitals following its regulatory approval by the Ministry of Health, Labour and Welfare in Japan in 2016 [10]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call