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PharmacoEconomics
Published in: PharmacoEconomics 1/2024

26-09-2023 | Deep Brain Stimulation | Systematic Review

Economic Evaluations Comparing Deep Brain Stimulation to Best Medical Therapy for Movement Disorders: A Meta-Analysis

Authors: Melissa Lannon, Taylor Duda, Alexander Mastrolonardo, Ellissa Huang, Amanda Martyniuk, Forough Farrokhyar, Feng Xie, Mohit Bhandari, Suneil K. Kalia, Sunjay Sharma

Published in: PharmacoEconomics | Issue 1/2024

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Abstract

Background

Movement disorders (Parkinson’s disease, essential tremor, primary dystonia) are a debilitating group of conditions that are progressive in nature. The mainstay of treatment is best medical therapy; however, a number of surgical therapies are available, including deep brain stimulation. Economic evaluations are an important aspect of evidence to inform decision makers regarding funding allocated to these therapies.

Objective

This systematic review and meta-analysis evaluated the cost effectiveness of including deep brain stimulation compared with best medical therapy for movement disorder indications in the adult population.

Methods

Ovid Medical Literature Analysis and Retrieval System Online, Embase, and Cochrane Central Register of Controlled Trials were queried. Only economic evaluations reporting incremental cost-effectiveness ratios for including deep brain stimulation versus best medical therapy for movement disorders were included. Studies were reviewed in duplicate for inclusion and data abstraction. Data were harmonized using the Consumer Price Index and Purchasing Power Parity to standardize values to 2022 US dollars. For inclusion in meta-analyses, studies were required to have sufficient data available to calculate an estimate of the incremental net benefit. Meta-analyses of pooled incremental net benefit based on the time horizon were performed. The study was registered at PROSPERO (CRD42022335436).

Results

There were 2190 studies reviewed, with 14 economic evaluations included following a title/abstract and full-text review. Only studies considering Parkinson’s disease were available for the meta-analysis. Quality of the identified studies was low, with moderate transferability to the American Healthcare System, and certainty of evidence was low. However, studies with a longer time horizon (15 years to lifetime) were found to have significant positive incremental net benefit (indicating cost effectiveness) for including deep brain stimulation with a mean difference of US$40,504.81 (95% confidence interval 2422.42–78,587.19).

Conclusions

Deep brain stimulation was cost effective for Parkinson’s disease when considered over the course of the patient’s remaining life after implantation.

Trial Registration

Clinical Trial Registration: PROSPERO (CRD42022335436).
Appendix
Available only for authorised users
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Metadata
Title
Economic Evaluations Comparing Deep Brain Stimulation to Best Medical Therapy for Movement Disorders: A Meta-Analysis
Authors
Melissa Lannon
Taylor Duda
Alexander Mastrolonardo
Ellissa Huang
Amanda Martyniuk
Forough Farrokhyar
Feng Xie
Mohit Bhandari
Suneil K. Kalia
Sunjay Sharma
Publication date
26-09-2023
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 1/2024
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.1007/s40273-023-01318-y

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