PMD10 - Cost-Minimisation Analysis of MR-GUIDED Focused Ultrasound Therapy Compared to Deep Brain Stimulation in Patients with Essential Tremor

Abstract

To conduct a cost-minimisation analysis of MR-guided focused ultrasound (MRgFUS) against unilateral deep brain stimulation therapy (DBS) for patients with essential tremor. The analysis was conducted by calculating the total costs for pre-procedure, procedure, and post-procedure for each therapy. The time horizon for the analysis was set at 3 months post-procedure. Two scenarios were set, one with and the other without the labor costs for healthcare providers. Medical care costs other than labor costs were estimated via two ways, fee-for-service (FFS) system and DRG-based fixed-payment system (so-called DPC system in Japan). Labor costs were calculated based on the proposed tariff by the Japanese Health Insurance Federation for Surgery (Gaihoren). Sensitivity analyses were also conducted to test the impact of the following parameters: 1) DBS removal rate, 2) inclusion/exclusion of labor costs, and 3) duration of hospitalisation, on overall treatment costs. MRgFUS proved to be cost-saving intervention in the base case where labor cost was included, as well as in the scenario analysis, where labor cost was excluded. With labor cost included, MRgFUS would save JPY511,625 (FFS) or JPY456,365 (DPC) per procedure. Sensitivity analyses showed that even under the extreme case, under which no removal occurred in the DBS arm, and longest assumption for MRgFUS hospitalisation and shortest for DBS, MRgFUS would still be the cost-saving option. MRgFUS could be a cost-saving option against DBS regardless of the inclusion status of labor cost. This analysis is likely to be conservative, in that the treatment costs for adverse events associated with each procedure, other than hardware removal with DBS, were not included.