Abstract
BackgroundParkinson’s disease (PD) is a debilitating illness associated with considerable impairment of quality of life and substantial costs to health care systems. Deep brain stimulation (DBS) is an established surgical treatment option for some patients with advanced PD. The EARLYSTIM trial has recently demonstrated its clinical benefit also in patients with early motor complications. We sought to evaluate the cost-effectiveness of DBS, compared to best medical therapy (BMT), among PD patients with early onset of motor complications, from a United Kingdom (UK) payer perspective.MethodsWe developed a Markov model to represent the progression of PD as rated using the Unified Parkinson's Disease Rating Scale (UPDRS) over time in patients with early PD. Evidence sources were a systematic review of clinical evidence; data from the EARLYSTIM study; and a UK Clinical Practice Research Datalink (CPRD) dataset including DBS patients. A mapping algorithm was developed to generate utility values based on UPDRS data for each intervention. The cost-effectiveness was expressed as the incremental cost per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were undertaken to explore the effect of parameter uncertainty.ResultsOver a 15-year time horizon, DBS was predicted to lead to additional mean cost per patient of £26,799 compared with BMT (£73,077/patient versus £46,278/patient) and an additional mean 1.35 QALYs (6.69 QALYs versus 5.35 QALYs), resulting in an incremental cost-effectiveness ratio of £19,887 per QALY gained with a 99% probability of DBS being cost-effective at a threshold of £30,000/QALY. One-way sensitivity analyses suggested that the results were not significantly impacted by plausible changes in the input parameter values.ConclusionThese results indicate that DBS is a cost-effective intervention in PD patients with early motor complications when compared with existing interventions, offering additional health benefits at acceptable incremental cost. This supports the extended use of DBS among patients with early onset of motor complications.
Highlights
Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder involving dopaminergic neurons, which results in a lack of the neurotransmitter dopamine
We developed a Markov model to represent the progression of PD as rated using the Unified Parkinson's Disease Rating Scale (UPDRS) over time in patients with early PD
Over a 15-year time horizon, Deep brain stimulation (DBS) was predicted to lead to additional mean cost per patient of £26,799 compared with best medical therapy (BMT) (£73,077/patient versus £46,278/patient) and an additional
Summary
Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder involving dopaminergic neurons, which results in a lack of the neurotransmitter dopamine. The hallmark of PD is a movement disorder with bradykinesia, rigidity and often rest tremor, non-motor signs and symptoms are common [1,2]. During early stages of the disease, patients are effectively treated with oral medication such as levodopa; over time, medication-induced motor complications such as unpredictable fluctuations in motor symptoms and abnormal involuntary movements (dyskinesias) develop [4]. In advanced stages axial motor signs such as impaired balance and gait that respond less favourably to levodopa or DBS become more prevalent and non-motor, especially psychiatric and cognitive problems cause significant loss of quality of life [4,5,6,7,8]. We sought to evaluate the cost-effectiveness of DBS, compared to best medical therapy (BMT), among PD patients with early onset of motor complications, from a United Kingdom (UK) payer perspective
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