Refractory Obsessive-compulsive Disorder Research Articles

Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study

BackgroundThe safety and efficacy of neuroablation (ABL) and deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) has not been examined. This study sought to generate a definitive comparative...

Deep brain stimulation and treatment-resistant obsessive-compulsive disorder: A systematic review

IntroductionAt least 10% of patients with Obsessive-compulsive Disorder (OCD) are refractory to psychopharmacological treatment. The emergence of new technologies for the modulation of altered neuronal activity in Neurosurgery, deep brain stimulation (DBS), has enabled its use in severe and refractory OCD cases. The objective of this article is to review the current scientific evidence on the effectiveness and applicability of this technique to refractory OCD. MethodWe systematically reviewed the literature to identify the main characteristics of deep brain stimulation, its use and applicability as treatment for obsessive-compulsive disorder. Therefore, we reviewed PubMed/Medline, Embase and PsycINFO databases, combining the key-words ‘Deep brain stimulation’, ‘DBS’ and ‘Obsessive-compulsive disorder’ ‘OCS’. The articles were selected by two of the authors independently, based on the abstracts, and if they described any of the main characteristics of the therapy referring to OCD: applicability; mechanism of action; brain therapeutic targets; efficacy; side-effects; co-therapies. All the information was subsequently extracted and analysed. ResultsThe critical analysis of the evidence shows that the use of DBS in treatment-resistant OCD is providing satisfactory results regarding efficacy, with assumable side-effects. However, there is insufficient evidence to support the use of any single brain target over another. Patient selection has to be done following analyses of risks/benefits, being advisable to individualise the decision of continuing with concomitant psychopharmacological and psychological treatments. ConclusionsThe use of DBS is still considered to be in the field of research, although it is increasingly used in refractory-OCD, producing in the majority of studies significant improvements in symptomatology, and in functionality and quality of life. It is essential to implement random and controlled studies regarding its long-term efficacy, cost-risk analyses and cost/benefit.

Radiosurgery for Behavioral Disorders.

Psychiatric illnesses create great suffering for patients and the medical solution is sometimes limited. The experience observed after treating patients with obsessive-compulsive disorder (OCD), depression, and anorexia nervosa by Gamma Knife radiosurgery (GKRS) is presented. Ten patients with medically refractory OCD, 3 patients with depression resistant to medical treatment and electroconvulsive therapy, and 5 patients with refractory anorexia nervosa have been treated. Bilateral anterior capsulotomy has been performed to treat OCD and bilateral cingulotomy has been applied to treat severe depression and anorexia nervosa. The accumulated experience about treatment of OCD by GKRS is reviewed. In our experience, 70% of OCD patients achieved a full response. We observed a significant improvement in patients with depression and anorexia nervosa evidenced by the scales of assessment (mean reduction of 40% in the Beck Depression Inventory at 1-year follow-up and 40% average increase of body mass index at 6-month follow-up). No side effects have been observed. These procedures are effective in reducing obsession, compulsion, depression, and anxiety, improving the quality of life of the patients without side effects.

Combined fluvoxamine and extended-release methylphenidate improved treatment response compared to fluvoxamine alone in patients with treatment-refractory obsessive-compulsive disorder: A randomized double-blind, placebo-controlled study

More effective, tolerable interventions for treatment-refractory obsessive-compulsive disorder (OCD) are needed. Preliminary findings encourage optimism that methylphenidate augmentation may be of benefit in the treatment of OCD. To test modulator methylphenidate (MPH) of extended-release formulations (MPH-ER) a safe and effective add-on therapy for refractory OCD, a pilot randomized, placebo-controlled, double-blind trial was conducted at an outpatient, single-center academic setting. Participants included 44 adults with serotonin reuptake inhibitor (SRI) treatment-refractory OCD and receiving a stable fluvoxamine pharmacotherapy with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores higher than 20. Data were analyzed in the intention-to-treat sample. All subjects were randomized into two parallel groups to receive fluvoxamine (250 mg daily) plus MPH-ER (36 mg daily) or fluvoxamine (250 mg daily) plus identical placebo tablets under double-blind conditions and followed for 8 weeks. Forty-four patients (29 [66%] men), with a mean (SD) age of 24.7 (6) years participated; with a mean (SD) duration of episode 5.7 (3) were randomized and forty-one finished the trial. In the intention-to-treat analysis, the improvement in the Y-BOCS total score and Y-BOCS obsession subscale score was more prominent in the fluvoxamine and MPH-ER group compared with those receiving placebo (P < .001). Additionally, cumulative response rates were higher in the MPH-ER vs placebo groups (59% vs 5%; P < .001). MPH-ER was well tolerated; No subjects dropped out due to side effects. In summary, combined treatment with MPH-ER demonstrated an enhanced clinical rate of response compared to placebo. Further trials should examine MPH-ER efficacy in a larger sample

Immediate Effects of Transcranial Direct Current Stimulation on Obsession-Induced Anxiety in Refractory Obsessive-Compulsive Disorder: A Pilot Study.

Studies have shown that transcranial direct current stimulation (tDCS) has immediate effects on brain activity. The aim of this study was to investigate the potential use of tDCS to regulate obsession-induced anxiety immediately after symptom provocation in patients with refractory obsessive-compulsive disorder (OCD). Twelve patients with refractory OCD received cathode, anode, and sham transcranial direct current stimulation over the medial prefrontal cortex conjugant to pharmacological treatment in a crossover design. Before and after the DC stimulation, patients graded the intensity of their anxiety after a short exposure to a provoking stimulus using the visual analogue scale. Clinical questionnaires assessing symptoms severity were also applied before each stimulation mode. We found a statistically significant decrease in the severity of the obsession-induced anxiety (decreased visual analogue scale) as a result of cathode tDCS in comparison with the anode and sham stimulation. Reduction in obsession-induced anxiety was consistent, yet short lasting, and was independent of symptom severity. Cathode tDCS could be potentially used to regulate obsession-induced anxiety in refractory OCD patients. Further studies are warranted to confirm our results as well as to determine whether tDCS can achieve prolonged benefits in OCD and be of aid in behavioral treatments based on exposure.

Deep brain stimulation for obsessive compulsive disorder: A review of results by anatomical target.

Studies suggest deep brain stimulation (DBS) as a treatment modality for the refractory obsessive-compulsive disorder (OCD). It is unclear where to place the DBS. Various sites are proposed for placement with the ventral capsule/ventral striatum (VC/VS) among the most studied. Herein, we aim to summarize both quantitative Yale-Brown Obsessive-Compulsive Scale (YBOCS) data and qualitative descriptions of the participants’ symptoms when given. A literature search conducted via PubMed yielded 32 articles. We sought to apply a standard based on the utilization of YBOCS. This yielded 153 distinct patients. The outcome measure we focused on in this review is the latest YBOCS score reported for each patient/cohort in comparison to the location of the DBS. A total of 32 articles were found in the search results. In total, 153 distinct patients’ results were reported in these studies. Across this collection of papers, a total of 9 anatomic structures were targeted. The majority of studies showed a better response at the last time point as compared to the first time point. Most patients had DBS at nucleus accumbens followed by VC/VS and the least patients had DBS at the bilateral superolateral branch of the median forebrain bundle and the bilateral basolateral amygdala. The average YBOCS improvement did not seem to directly correlate with the percentile of patients responding to the intervention.Well-controlled, randomized studies with larger sample sizes with close follow up are needed to provide a more accurate determination for placement of DBS for OCD.

Deep brain stimulation for obsessive compulsive disorder: A review of results by anatomical target

Studies suggest deep brain stimulation (DBS) as a treatment modality for the refractory obsessive-compulsive disorder (OCD). It is unclear where to place the DBS. Various sites are proposed for placement with the ventral capsule/ventral striatum (VC/VS) among the most studied. Herein, we aim to summarize both quantitative Yale-Brown Obsessive-Compulsive Scale (YBOCS) data and qualitative descriptions of the participants' symptoms when given. A literature search conducted via PubMed yielded 32 articles. We sought to apply a standard based on the utilization of YBOCS. This yielded 153 distinct patients. The outcome measure we focused on in this review is the latest YBOCS score reported for each patient/cohort in comparison to the location of the DBS. A total of 32 articles were found in the search results. In total, 153 distinct patients' results were reported in these studies. Across this collection of papers, a total of 9 anatomic structures were targeted. The majority of studies showed a better response at the last time point as compared to the first time point. Most patients had DBS at nucleus accumbens followed by VC/VS and the least patients had DBS at the bilateral superolateral branch of the median forebrain bundle and the bilateral basolateral amygdala. The average YBOCS improvement did not seem to directly correlate with the percentile of patients responding to the intervention. Well-controlled, randomized studies with larger sample sizes with close follow up are needed to provide a more accurate determination for placement of DBS for OCD.

Pharmacotherapy for treatment-respondent vs. refractory obsessive–compulsive disorder in children and adults: strategies, meta-analyses and clinical guidelines

Obsessive–compulsive disorder (OCD) is a common mental and anxiety disorders occurs at all ages, but more common in younger ages with uncontrollable, and affects 1–1.5% of the general population. Many pharmacological therapies and drugs have been reported to diminish OCD symptoms, as well as increase quality of life. So far, several meta-analyses, however, have directly compared such treatment approaches in OCD and treatment-resistant OCD patients. This review evaluated all treatment options for OCD in both children and adolescents, and aimed to found if existing pharmacological therapies work similarly well, taking into account medical comorbidities such as substance use, anxiety, metabolic disorders, and finally, an overview of issues related to safety and monitoring. Our review included data from 16 meta-analyses and 8 practical guidelines involving OCD patients. In adults with OCD, we found that combined therapy shows favorable outcome versus SRI alone and produced better results. In children with OCD greatest incremental treatment gains occur early in SSRI treatment. Finally in treatment-resistant OCD patients antipsychotic augmentation of SRIs can be regarded as an evidence-based measure for pharmacological therapy. The results of this review mostly support the formerly published reviews on the pharmacological management of OCD. Albeit we could confirm that combination/augmentation of SSRIs significantly improved symptoms in treatment-resistant OCD patient than monotherapy. From a clinical perspective, antipsychotics combination/augmentation of SSRIs should be favorably used if there are comorbidities psychosis that represents a frequent comorbidity in OCD, especially the presence of comorbidities is highly associated with treatment-resistance OCD condition.

The Keys to DBS Effectiveness: Location, Location, Location

Deep brain stimulation (DBS) can be life changing in some, but not all, patients with highly refractory obsessive-compulsive disorder (OCD). To explore

BLOOD LEVELS OF TREATMENT RESISTANT OBSESSIVE-COMPULSIVE DISORDER PATIENTS PRESCRIBED SUPRA-NORMAL DOSAGES OF SERTRALINE

. Aims This study examined the blood levels of Sertraline in patients with profound, refractory Obsessive-Compulsive Disorder (OCD) and who were prescribed dosages in excess of recommended limits. Background Studies in patients with OCD have demonstrated that higher levels of serotonin reuptake inhibiting (SRI) drugs are usually needed to obtain remission that those required for depression. This observation led some workers to suggest that supra-normal doses of selective SRIs may prove beneficial in treatment refractory patients. Pampaloni et al. (2010) found that these high doses of selective SRIs were well tolerated in treatment refractory patients and led to clinical improvement. The aim of this study was to examine the blood levels of patients prescribed supra-normal doses of Sertraline. If the blood levels remained within therapeutic range, then this would suggest that these patients either have reduced absorption of the drug or were rapidly metabolising Sertraline. Methods Patients selected for the study had all been admitted to the National Inpatient Service for OCD/BDD based in South West London and St George’s NHS Trust. This Unit has been described elsewhere (Drummond et al., 2012). Owing to the wards admission criteria, all the patients had previously received at least two trials of different SSRIs or Clomipramine for a minimum of 3 months each without any resolution of symptoms. In addition, all patients had received augmentation with a dopamine blocker and also at least 2 trials of Exposure and response-prevention psychological therapy. Despite these treatments, all patients were admitted to the service with a Yale-Brown Obsessive Compulsive Score within the high end of the “profoundly ill” range (>35/40). Successively admitted patients who were prescribed Sertraline in doses greater than the recommended 200mg per day were included in the study. These patients who were initially unresponsive to 200mg Sertraline had their daily doses titrated upwards in 50mg increases every 2-4 weeks up to a maximum of 400mg (depending on efficacy and any side effects). Blood samples were taken shortly after their morning dose had been administered. This was after the patients had stabilised for at least 2 weeks on the higher doses. Results 7 patients were included in the study. Blood levels of Sertraline were found to be in therapeutic range for all patients. In general, the blood levels remained within the lower half of normal reference range despite being prescribed supra-normal Sertraline dosages ranging from 250mg to 400mg per day. Conclusion This study demonstrates that some patients who are refractory to standard doses have blood levels within the therapeutic range. This finding suggests that these patients either absorb the drug poorly or metabolise it rapidly.

Informed Consent Decision-Making in Deep Brain Stimulation.

Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson’s disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessive-compulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity. Most of the disorders in which DBS has been used might present with alterations in memory, attention, and executive functioning, which may have an impact on the mental capacity to give informed consent to neurosurgery. Depression, anxiety, and compulsivity are also common in DBS candidate disorders, and could also be associated with an impaired capacity to consent to treatment or clinical research. Despite these issues, there is limited empirical knowledge on the decision-making levels of these patients. The possible informed consent issues of DBS will be discussed by focusing on the specific treatable diseases.

Dissociable Frontostriatal Connectivity: Mechanism and Predictor of the Clinical Efficacy of Capsulotomy in Obsessive-Compulsive Disorder

BackgroundLittle is known about the neural mechanism and response variability underlying neurosurgical interventions for intractable obsessive-compulsive disorder (OCD). MethodsOf 81 OCD patients screened for capsulotomy identified in our institutional database, 36 patients with clinical assessment before and after capsulotomy and imaging data (9 of 36 patients without postoperative imaging data used as an independent test group), and 29 healthy control subjects were retrospectively recruited. Twenty of 36 patients (56%) responded to the lesion procedure (determined as a ≥35% reduction in Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score). Seed-based (i.e., ventral and dorsal caudate, medial dorsal thalamus, and ventral and dorsal putamen) resting-state functional connectivity was used to examine alterations in frontostriatal circuitry after capsulotomy. ResultsThe Y-BOCS score significantly decreased (p < .001) after capsulotomy in OCD patients. Functional connectivity between the ventral striatum/nucleus accumbens and the dorsal anterior cingulate cortex was reduced (p < .05, corrected) after the surgical procedure. Moreover, change in connectivity significantly correlated with alteration in Y-BOCS score (r = .41, p = .033). In addition, preoperative connectivity between the dorsal caudate and the dorsal anterior cingulate cortex could differentiate nonresponders from responders and predict changes in Y-BOCS score (R2 = .23, F1,25 = 7.56, p = .011), which was generalized in an independent test group. ConclusionsWe demonstrated that restoration of ventral frontostriatal connectivity was associated with clinical improvement in refractory OCD, suggesting a therapeutic mechanism of capsulotomy. Moreover, preoperative variations in dorsal frontostriatal connectivity predicted clinical response, which may offer a predictor of treatment outcome.

S174. Remotely Programmed Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Intractable Obsessive Compulsive Disorder

Treatment refractory obsessive-compulsive disorder (OCD) is a disabling condition. Deep brain stimulation (DBS) of the ventral capsule/ventral striatum(VC/VS) has demonstrated safety and effectiveness for severe, chronic, treatment-resistant OCD. However, programming is a crucial aspect of DBS that requires laborious titration to set optimal parameters.

The Place of Antipsychotics in the Therapy of Anxiety Disorders and Obsessive-Compulsive Disorders.

The purpose of this review was to assess and present the findings up to this date on the efficacy of antipsychotics in the treatment of generalized anxiety disorders (GAD), social anxiety disorders (SAD), panic disorders (PD), and obsessive-compulsive disorders (OCD), mostly based on published randomized controlled trials (RCTs) or on open-label studies when RCT were lacking. Quetiapine could be recommended in patients with GAD. The efficacy of aripiprazole in two open-label studies on patients with antidepressant-refractory GAD should be assessed in RCTs. Despite preliminary positive results in open studies, there are currently no strong evidence for the effectiveness of antipsychotics in refractory SAD and in refractory PD. Conversely, risperidone and aripiprazole can be used for the treatment of refractory OCD as augmentation agents to antidepressants. Contrary to SAD and PD, this review found evidence for the use of second-generation antipsychotics in GAD and OCD. Otherwise, first-generation antipsychotics cannot be recommended in anxiety disorders and OCD.

Effects of Anterior Capsulotomy on Decision Making in Patients with Refractory Obsessive–Compulsive Disorder

Despite various lines of evidence implicating impaired decision-making ability in individuals with obsessive–compulsive disorder (OCD), neuropsychological investigation has generated inconsistent findings. Although the cortico-striato-thalamo-cortical (CSTC) circuitry has been suggested, the involvement of the cortex has not yet been fully demonstrated. Moreover, it is unknown whether surgical intervention on the CSTC circuitry results in a predicted improvement of decision-making ability of OCD. Here we present a study of decision making based on the Iowa Gambling Task (IGT) to investigate decision making in a large sample of individuals with treatment-resistant OCD with and without anterior capsulotomy (AC). Task performance was evaluated in healthy subjects, individuals with OCD that had not undergone surgery, and postsurgical OCD patients with AC. The latter group was further divided into a short-term postsurgical group and a long-term postsurgical group. We found that the OCD patients without surgery performed significantly worse than the healthy controls on the IGT. There were no significant differences in decision-making between the presurgical OCD patients and those at the short-term postsurgical follow-up. Decision-making ability of the long-term postsurgical OCD patients was improved to the level comparable to that of healthy controls. All clinical symptoms (OCD, depression, and anxiety) assessed by psychiatric rating scales were significantly alleviated post-surgically, but exhibited no correlation with their IGT task performance. Our findings provide strong evidence that OCD is linked to impairments in decision-making ability; that impaired CSTC circuitry function is directly involved in the manifestation of OCD; and that AC related improvements in cognitive functions are caused by long-term plasticity in the brain circuitry.

Clinical Outcomes improvement of refractory Obsessive compulsive disorder by use Olanazapine

More than half of the patients with obsessive- compulsive disorder(OCD) remain unimproved by Serotonin-Reuptake inhibitors(SSRI). objective of this study was to examine whether addition of atypical antipsychotic (olanzapine ) to Sertraline is useful for patients with OCD who do not respond to SSRI monotherapy.1. According to (DSM IV-TR criteria) , 20 patients are diagnosed asOCD and did not responded to Sertraline at dose 100-150mg/day2. Olanazapine was additional treatment , start 2.5mg/day at first monththen 5 mg/day for last two months of study&#x0D; 3. Treatment response was assessed using the Yale-Brown Obsessive- Compulsive Scale (YBOCS) at end of each months of study 16 of 20 patients respond to the olanzapine augmented sertraline therapy .&#x0D; The mean baseline YBOCS score of 32.75 dropped to a mean of 21.75 at endpoint for male with reduction 12.81% from baseline. While in female, the mean baseline YBOCS score of 33.83 dropped to amean of 21.67 at endpoint with reduction 17.06% from baseline. Treatment-refractory OCD Patients may benefit from addition of olanzapine to ongoing SSRI therapy.

Long-term efficacy of bilateral deep brain stimulation of the anterior limb of the internal capsule for refractory obsessive-compulsive disorder

Objective To assess the long-term clinical efficacy of bilateral deep brain stimulation (DBS) of the anterior limb of the internal capsule (ALIC) for refractory obsessive-compulsive disorder (OCD). Methods Four patients with definite diagnosis of refractory OCD underwent bilateral DBS of ALIC at Department of Neurosurgery, Aviation General Hospital of China Medical University during the period from June 2010 to February 2012, and their clinical data were retrospectively analyzed. Symptoms were assessed according to the Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton depression rating scale (HAMD), Hamilton anxiety rating scale (HAMA), and personal and social performance scale (PSP) before and 6, 12, 36 months after operation. At the same time, all patients underwent PET-CT examination before surgery and 6 months after surgery, and the changes of metabolism in brain nuclei were evaluated. Results The 4 patients were followed up for 38-64 months (all beyond 36 months). The improvement rate was 25.0%-100.0% in terms of Y-BOCS score, 25.8%-100.0% in terms of HAMD score, and 27.3%-100.0% in terms of HAMA score. The PSP score indicated that the patients' personal and social functional activities improved significantly. The PET-CT examination suggested that brain structures with low metabolism assessed preoperatively demonstrated improvement with varying degrees at 6 months post surgery. In addition, the patients obtained significant improvement in terms of anxiety, depression and functional activities. None of the patients developed severe surgery-related complications. Conclusion Bilateral ALIC-DBS seems to be an effective and safe approach for the treatment of refractory OCD with minimal invasiveness, low rate of complications, benefits in anxiety and depression management and improvement of the patient's life quality. Key words: Obsessive-compulsive disorder; Anterior limb of the internal capsul; Deep brain stimulation; Prognosis

Buprenorphine augmentation improved symptoms of OCD, compared to placebo - Results from a randomized, double-blind and placebo-controlled clinical trial

BackgroundIn the search for new psychopharmacologic options in the treatment of obsessive-compulsive disorders (OCD), some findings suggested that augmentation with buprenorphine, a partial-opioid agonist used to treat opioid addiction, moderate acute pain and moderate chronic pain, is worthy of consideration. Accordingly, to explore this possibility further, a double-blinded, placebo-controlled clinical trial was performed. MethodA total of 43 patients (mean age: 34.41 years; SD = 6.58; 53.5% males) with refractory OCD and treated with SSRIs or clomipramine at therapeutic dosages were randomly assigned either to an adjuvant buprenorphine or to an adjuvant placebo condition. Patients completed the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) at baseline, weeks 3, 9 and 12 (study completion). Buprenorphine (2–4 mg; sublingual) and placebo (tablets with identical shape, color, consistency, and scent) were given daily. ResultsSymptoms of obsessive-compulsive disorders decreased over time, but more so in the buprenorphine than in the placebo condition. Substantial improvements were observed up to week 3 and then 9. Response and partial response were observed in the buprenorphine at week 9 more than in the placebo condition. The advantage had disappeared by week 12. ConclusionsThe pattern of results suggests that adjuvant buprenorphine augmentation can reduce symptoms of obsessive-compulsive disorders after only three weeks, compared to a placebo. Adjuvant buprenorphine seems to accelerate symptom improvement.

ARIPIPRAZOLE AUGMENTATION IN PROFOUND, SRI-REFRACTORY OBSESSIVE-COMPULSIVE DISORDER

Background The National Inpatient service for Obsessive-Compulsive Disorder (OCD) And Body Dysmorphic Disorders (BDD), funded by NHS England, is the only 24-hour staffed dedicated inpatient facility for profound, refractory OCD in the UK. Although OCD is a common and frequently disabling condition, often responds well to treatment with either Cognitive Behavioural Therapy or SRI. Pharmacological strategies utilized in SRI non-responders include, amongst the others, the use of first or second-generation antipsychotics. David Veale et al (2014) highlighted in A recent Meta-analysis that two studies found Aripiprazole to be effective in the short term. The aim of this study was to look at the use of Aripiprazole compared to other antipsychotics in the National OCD Service for all the patients admitted between March 2006 and September 2011. Method data were gathered from case records, electronic records system. We used the Yale Brown Obsessive-Compulsive Rating Scale (YBOCS) to measure severity. Results our sample consisted of 89 patients (45 males and 44 females) with an initial YBOCS average score of 23.5± 2.9 SD, indicating profound OCD. Overall, the highest number of patients (n=30) patients were treated with Aripiprazole when discharged from the National Service. Patients whose treatment was augmented with Aripiprazole, displayed an average YBOCS reduction of 14. Conclusions Aripiprazole was widely used in our population of inpatients with profound, treatment-refractory OCD, producing a reduction in the YBOCS scores

Cost-effectiveness of deep brain stimulation versus treatment as usual for obsessive-compulsive disorder

BackgroundDeep Brain Stimulation (DBS) is effective for obsessive-compulsive disorder (OCD), but requires expensive medical procedures. To date, no study has examined the cost-effectiveness of DBS for OCD. ObjectiveTo perform the first economic evaluation of DBS for therapy refractory OCD. MethodsWe conducted a 2-year prospective, open cost-effectiveness study, comparing DBS (n = 17) with treatment as usual (TAU) (n = 11), with cost per Quality-Adjusted-Life-Year (QALY) as outcome measure. Apart from the base-case, or primary analysis, we conducted two practice-based scenarios: (1) standard care scenario, without research and innovation costs, and (2) rechargeable scenario, in which we assume the use of a rechargeable battery. Base-case and both scenarios were extrapolated to four years to estimate long-term cost-effectiveness. ResultsCompared to TAU, DBS provides an additional 0.26 QALY (SD = 0.16). Median cost per QALY gained is estimated at €141,446 for base-case, €115,916 for standard care and €65,394 for the rechargeable scenario. Extending the time-horizon to four years results in a median cost per QALY of €80,313 for base-case, €69,287 for standard care, and turned out to be cost-saving at €4678 per QALY for the rechargeable scenario. Assuming a willingness to pay threshold of €80,000/QALY, DBS, under base-case and standard care had 25% and 35% probability of being more cost-effective than TAU. With the rechargeable scenario and in all scenarios extrapolated to four years, the probability of cost-effectiveness was equal or higher than TAU. ConclusionsThis study indicates DBS for OCD is cost-effective in the long-term, especially when rechargeable batteries are taken into account.