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Open Access 01-01-2014 | Original Communication

The cost-effectiveness of deep brain stimulation in combination with best medical therapy, versus best medical therapy alone, in advanced Parkinson’s disease

Authors: Simon Eggington, Francesc Valldeoriola, K. Ray Chaudhuri, Keyoumars Ashkan, Elena Annoni, Günther Deuschl

Published in: Journal of Neurology | Issue 1/2014

Abstract

Parkinson’s disease (PD) is a complex progressive movement disorder leading to motor and non-motor symptoms that become increasingly debilitating as the disease advances, considerably reducing quality of life. Advanced treatment options include deep brain stimulation (DBS). While clinical effectiveness of DBS has been demonstrated in a number of randomised controlled trials (RCT), evidence on cost-effectiveness is limited. The cost-effectiveness of DBS combined with BMT, versus BMT alone, was evaluated from a UK payer perspective. Individual patient-level data on the effect of DBS on PD symptom progression from a large 6-month RCT were used to develop a Markov model representing clinical progression and capture treatment effect and costs. A 5-year time horizon was used, and an incremental cost-effectiveness ratio (ICER) was calculated in terms of cost per quality-adjusted life-years (QALY) and uncertainty assessed in deterministic sensitivity analyses. Total discounted costs in the DBS and BMT groups over 5 years were £68,970 and £48,243, respectively, with QALYs of 2.21 and 1.21, giving an incremental cost-effectiveness ratio of £20,678 per QALY gained. Utility weights in each health state and costs of on-going medication appear to be the key drivers of uncertainty in the model. The results suggest that DBS is a cost-effective intervention in patients with advanced PD who are eligible for surgery, providing good value for money to health care payers.

Reider CR, Halter CA, Castellucci PF, Oakes D, Nichols WC, Foroud T (2003) Reliability of reported age at onset for Parkinson’s disease. Mov Disord 18(3):275–279CrossRefPubMed

Wickremaratchi MM, Perera D, O’Loghlen C, Sastry D, Morgan E, Jones A, Edwards P, Robertson NP, Butler C, Morris HR, Ben-Shlomo Y (2008) Prevalence and age of onset of Parkinson’s disease in Cardiff: a community based cross sectional study and meta-analysis. J Neurol Neurosurg Psychiatry 80(7):805–807CrossRef

Porter B, MacFarlane R, Unwin N, Walker R (2006) The prevalence of Parkinson’s disease in an area of North Tyneside in the North-East of England. Neuroepidemiology 26:156–161CrossRefPubMed

Newman EJ, Grosset KA, Grosset DG (2009) Geographical difference in Parkinson’s disease prevalence within West Scotland. Mov Disord 24(3):401–406CrossRefPubMed

Morgante L, Nicoletti A, Epifanio A (2008) Prevalence of Parkinson’s disease and other types of parkinsonism in the Aeolian Archipelago, Sicily. Parkinsonism Relat Disord 14(7):572–575CrossRefPubMed

Ahlskog JE, Muenter MD (2001) Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature. Mov Disord 16:448–458CrossRefPubMed

Idaji JA, Aharonoff GB, Su H, Richmond J, Egol KA, Zuckerman JD, Koval KJ (2005) Hip fracture outcomes in patients with Parkinson’s disease. Am J Orthop 34(7):341–346

Winter Y, von Campenhausen S, Brozova H, Skoupa J, Reese JP, Bötzel K, Eggert K, Oertel WH, Dodel R, Ruzicka E (2010) Costs of Parkinson’s disease in Eastern Europe: a Czech cohort study. Parkinsonism Relat Disord 16(1):51–56CrossRefPubMed

Quittenbaum BH, Grahn B (2004) Quality of life and pain in Parkinson’s disease: a controlled cross-sectional study. Parkinsonism Relat Disord 10:129–136CrossRefPubMed

10.

Riazi A, Hobart JC, Lamping DL, Fitzpatrick R, Freeman JA, Jenkinson C, Peto V, Thompson AJ (2003) Using the SF-36 measure to compare the health impact of multiple sclerosis and Parkinson’s disease with normal population health profiles. J Neurol 74:710–714

11.

Schrag A, Jahanshahi M, Quinn N (2000) What contributes to quality of life in patients with Parkinson’s disease? J Neurol Neurosurg Psychiatry 69:308–312PubMedCentralCrossRefPubMed

12.

Valeikiene V, Ceremnych J, Alekna V, Juozulynas A (2008) Differences in WHOLQOL-100 domain scores in Parkinson’s disease and Osteoarthritis. Med Sci Monit 14(4):CR221–CR227PubMed

13.

Rahman S, Griffin HJ, Quinn NP (2008) Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord 23(10):1428–1434CrossRefPubMed

14.

Visser M, van Rooden SM, Verbaan D, Marinus J, Stiggelbout AM, van Hilten JJ (2008) A comprehensive model of health-related quality of life in Parkinson’s disease. J Neurol 255(10):1580–1587CrossRefPubMed

15.

Visser M, Verbaan D, van Rooden SM (2009) A longitudinal evaluation of health-related quality of life of patients with Parkinson’s disease. Value Health 12(2):392–396CrossRefPubMed

16.

Montel S, Bonnet A-M, Bungener C (2009) Quality of life in relation to mood, coping strategies and dyskinesia in Parkinson’s disease. J Geriatr Psychiatry Neurol 22(2):95–102CrossRefPubMed

17.

Grosset KA, Grosset DG (2005) Patient-perceived involvement and satisfaction in Parkinson’s disease: effect on therapy decisions and quality of life. Mov Disord 20(5):616–619CrossRefPubMed

18.

Michalowska M, Fiszer U, Krygowska-Wajs A, Owczarek K (2011) Falls in Parkinson’s disease. Causes and impacts on patients’ quality of life. Funct Neurol 20(4):163–168

19.

Marras C, McDermott MP, Rochon PA, Tanner CM, Naglie G, Lang AE (2008) Predictors of deterioration in health-related quality of life in Parkinson’s disease: results from the DATATOP trial. Mov Disord 23(5):653–659CrossRefPubMed

20.

Brozova H, Stochl J, Roth J, Ruzicka E (2009) Fear of falling has greater influence than other aspects of gait disorders on quality of life in patients with Parkinson’s disease. Neuro Endocrinol Lett 30(4):453–456PubMed

21.

Global Parkinson’s Disease Survey (GPDS) Steering Committee (2002) Factors impacting on quality of life in Parkinson’s disease: results from an international survey. Mov Disord 17(1):60–67CrossRef

22.

Gomez-Esteban JC, Zarranz JJ, Lezcano E, Garcia-Ruiz P, Rojo A, Salvador A, Castro A, Grandas F, Kulisevsky J, Martí MJ, Martinez-Martin P, Relova L, Rumia J, Camara A, Burguera JA, Linazasoro G, de Val JL, Obeso J, Rodriguez-Oroz MC, Tolosa E (2007) Influence of motor symptoms upon the quality of life of patients with Parkinson’s disease. Eur Neurol 57(3):161–165CrossRefPubMed

23.

Klepac N, Hajnsek S, Trkulja V (2010) Impact of pre-morbid depression on health-related quality of life in non-demented Parkinson’s disease patients. Parkinsonism Relat Disord 16(1):21–27CrossRefPubMed

24.

Stewart KC, Fernandez HH, Okun MS, Jacobson CE, Hass CJ (2008) Distribution of motor impairment influences quality of life in Parkinson’s disease. Mov Disord 23(10):1466–1468CrossRefPubMed

25.

Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ (2008) Determinants of disability and quality of life in mild to moderate Parkinson disease. Neurology 70(23):2241–2247CrossRefPubMed

26.

Péchevis M, Clarke CE, Vieregge P, Khoshnood B, Deschaseaux-Voinet C, Berdeaux G, Ziegler M (2005) Effects of dyskinesias in Parkinson’s disease on quality of life and health-related costs: a prospective European study. Eur J Neurol 12(12):956–963CrossRefPubMed

27.

Findley L, Aujla M, Bain PG, Baker M, Beech C, Bowman C, Holmes J, Kingdom WK, MacMahon DG, Peto V, Playfer JR (2003) Direct economic impact of Parkinson’s disease: a research survey in the United Kingdom. Mov Disord 18(10):1139–1145CrossRefPubMed

28.

Hagell P, Nordling S, Reimer J, Brabowski M, Persson U (2002) Resource utilisation and costs in a Swedish cohort of patients with Parkinson’s disease. Mov Disord 17(6):1213–1220CrossRefPubMed

29.

Findley L, Wood E, Bergman A, Schifflers M, Roeder C (2010) The economic burden of advanced Parkinson’s disease: an analysis of a UK patient dataset. Poster presentation at World Parkinson Congress, Glasgow

30.

Horstink M, Tolosa E, Bonuccelli U, Deuschl G, Friedman A, Kanovsky P, Larsen JP, Lees A, Oertel W, Poewe W, Rascol O, Sampaio C (2006) Review of the management of Parkinson’s disease. Report of a joint task force of the European Federation of Neurological Societies (EFNS) an.d the Movement Disorder Society-European Section (MDS-ES). Part II: late complicated) Parkinson’s disease. Eur J Neurol 13(11):1186–1202CrossRefPubMed

31.

Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, Daniels C, Deutschlander A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Medhorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wjtecki L, Wolf E, Poewe W, Voges J (2006) A randomized trial of deep-brain stimulation for Parkinson’s disease. New Engl J Med 355(9):896–908CrossRefPubMed

32.

Weaver F, Follett K, Stern M, Hur K, Harris C, Marks WJ Jr, Rothlind J, Sagher O, Reda D, Moy CS, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein J, Stoner G, Heemskerk J, Huang GD (2009) Bilateral deep brain stimulation vs. best medical therapy for patients with advanced Parkinson disease: a randomised controlled trial. JAMA 301(1):63–73PubMedCentralCrossRefPubMed

33.

Williams A, Gill S, Varma T, Jenkinson C, Quinn N, Mitchell R, Scott R, Ives N, Rick C, Daniels J, Patel S, Wheatley K (2010) Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PDSURG trial): a randomised, open-label trial. Lancet 9(6):581–591PubMedCentralCrossRefPubMed

34.

Schüpbach WMM, Maltête D, Houeto JL, du Montcel ST, Mallet L, Welter ML, Gargiulo M, Behar C, Bonnet AM, Czernecki V, Pidoux B, Navarro S, Dormont D, Cornu P, Agid Y (2007) Neurosurgery at an earlier stage of Parkinson disease: a randomized, controlled trial. Neurology 68:267–271CrossRefPubMed

35.

Okun MS, Gallo BV, Mandybur G, Jagid J, Foote KD, Revilla FJ, Alterman R, Jankovic J, Simpson R, Junn F, Verhagen L, Arle JE, Ford B, Goodman RR, Stewart RM, Horn S, Baltuch GH, Kopell BH, Marshall F, Peichel D, Pahwa R, Lyons KE, Troster AI, Vitek JL, Tagliati M (2012) Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol 11:140–149CrossRefPubMed

36.

Fox SH, Katzenschlager R, Lim SY, Ravina B, Seppi K, Coelho M, Poewe W, Rascol O, Goetz CG, Sampaio C (2012) The Movement Disorder Society evidence-based medicine review update: treatments for motor symptoms of Parkinson’s disease. Mov Disord 23(S3):S2–S41

37.

National Institute for Health and Clinical Excellence (NICE) (2003) Deep brain stimulation for Parkinson’s disease. Interventional Procedure Guideline No. 19

38.

National Institute for Health and Clinical Excellence (NICE) (2006) Parkinson’s disease: diagnosis and management in primary and secondary care. Clinical Guideline No. 35

39.

Valldeoriola F, Morsi O, Tolosa E, Rumia J, Martí MJ, Martinez-Martin P (2007) Prospective comparative study on cost-effectiveness of subthalamic stimulation and best medical treatment in advanced Parkinson’s disease. Mov Disord 22(15):2183–2191CrossRefPubMed

40.

Tomaszewski KJ, Holloway RG (2001) Deep brain stimulation in the treatment of Parkinson’s disease. Neurology 57:663–671CrossRefPubMed

41.

Goulionis JE, Vozikis A (2009) Medical decision making for patients with Parkinson disease under average cost criterion. Aust N Zeal Health Policy 6(15):1–8

42.

Dams J, Siebert U, Bornschein B, Volkmann J, Deuschl G, Oertel W, Dodel R, Reese J (2013) Cost-effectiveness of deep brain stimulation in patients with Parkinson’s disease. Mov Disord 28(6):763–771CrossRefPubMed

43.

Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442CrossRefPubMed

44.

National Institute for Health and Clinical Excellence (NICE) (2008) Guide to the methods of technology appraisal

45.

Zhao YJ, Wee HL, Chan Y-H, Seah SH, Au WL, Lau PN, Pica EC, Li SC, Luo N, Tan LC (2010) Progression of Parkinson’s disease as evaluated by Hoehn and Yahr stage transition times. Mov Disord 25(6):710–716CrossRefPubMed

46.

Palmer CS, Schmier JK, Snyder E, Scott B (2000) Patient preferences and utilities for ‘off-time’ outcomes in the treatment of Parkinson’s disease. Qual Life Res 9:819–827CrossRefPubMed

47.

Palmer CS, Nuijten MJC, Schmier JK, Subedi P, Snyder EH (2002) Cost-effectiveness of treatment of Parkinson’s Disease with entacapone in the United States. Pharmacoeconomics 20(9):617–628CrossRefPubMed

48.

Lowin J, Bergman A, Chaudhuri KR, Kindley LJ, Roeder C, Schifflers M, Wood E, Morris S (2011) A cost-effectiveness analysis of levodopa/carbidopa intestinal gel compared to standard care in late stage Parkinson’s disease in the UK. J Med Econ 14(5):584–593CrossRefPubMed

49.

Liou H-H, Wu C-Y, Chiu Y-H, Yen AM, Chen RC, Chen TF, Chen CC, Hwang YC, Wen YR, Chen TH (2009) Mortality of Parkinson’s disease by Hoehn–Yahr stage from community-based and clinic series (Keelung Community-based Integrated Screening (KCIS) No. 17). J Eval Clin Pract 15(4):587–591CrossRefPubMed

50.

Pickering RM, Grimbergen YAM, Rigney U, Ashburn A, Mazibrada G, Wood B, Gray P, Kerr G, Bloem BR (2007) A meta-analysis of six prospective studies of falling in Parkinson’s disease. Mov Disord 22(13):1892–1900CrossRefPubMed

51.

Bloem BR, Grimbergen YAM, Cramer M, Willemsen M, Zwinderman AH (2001) Prospective assessment of falls in Parkinson’s disease. J Neurol 248:950–958CrossRefPubMed

52.

McIntosh E, Gray A, Ouellet M (2009) PD SURG—health economics evaluation. http://www.pdmed.bham.ac.uk/investigators/documentation/PDSURG_presentation_May09.ppt. Accessed 13 Feb 2012

53.

British Medical Association and the Royal Pharmaceutical Society of Great Britain (2011) British National Formulary, 62nd edn. Pharmaceutical Press, UK

54.

Payment by Results Tariffs (2011–2012). Department of Health, UK

55.

Medtronic Neuromodulation Price List, United Kingdom (2010) DBS Therapies

56.

Curtis L (2010) Unit costs of health and social care 2010. Personal Social Services Research Unit, United Kingdom

57.

Weintraub D, Duda JE, Carlson K, Luo P, Sagher O, Stern M, Follett KA, Reda D, Weaver FM (2013) Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson’s disease: results from a randomised, controlled trial. J Neurol Neurosurg Psychiatry 84(10):1113–1118CrossRefPubMed

58.

Government Actuary’s Department, UK (2012) Interim Life Tables. http://www.gad.gov.uk/Demography%20Data/Life%20Tables/ (2007–2009). Accessed 13 Feb 2012

59.

Shimbo T, Kenji H, Takemura M, Fukui T (2001) Cost-effectiveness analysis of dopamine agonists in the treatment of Parkinson’s disease in Japan. Pharmacoeconomics 19(8):875–886CrossRefPubMed

60.

Schrag A, Jahanshahi M, Quinn N (2000) How does Parkinson’s affect quality of life? A comparison with quality of life in the general population. Mov Disord 15(6):1112–1118CrossRefPubMed

61.

Haycox A, Armand C, Murteira S, Cochran J, François C (2009) Cost-effectiveness of rasagiline and pramipexole as treatment strategies in early Parkinson’s disease in the UK setting. An economic Markov model evaluation. Drugs Aging 26(9):791–801CrossRefPubMed

62.

McCabe C, Claxton K, Culyer AJ (2008) The NICE cost-effectiveness threshold: what it is and what it means. Pharmacoeconomics 26(9):733–744CrossRefPubMed

63.

Owen L, Morgan A, Fischer A, Ellis S, Hoy A, Kelly MP (2012) The cost-effectiveness of public health interventions. J Public Health 34(1):37–45CrossRef

64.

Follett KA, Weaver FM, Stern M, Hur K, Harris CL, Luo P, Marks WJ Jr, Rothlind J, Sagher O, Moy C, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein JM, Stoner G, Starr PA, Simpson R, Baltuch G, De Salles A, Huang GD, Reda DJ (2010) Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease. New Engl J Med 362(21):35–49

65.

Hely MA, Morris JGL, Reid WG, Trafficante R (1999) Sydney multi-center study of Parkinson’s disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry 67:300–307PubMedCentralCrossRefPubMed

66.

Forsaa EB, Larsen JP, Wentzel-Larsen T, Alves G (2010) What predicts mortality in Parkinson disease: a prospective population-based long-term study. Neurology 75:1270–1276CrossRefPubMed

67.

Shearer J, Green C, Counsell CE, Zajicek JP (2011) The use of decision-analytic models in Parkinson’s disease: a systematic review and critical appraisal. Appl Health Econ Health Policy 9(4):243–258CrossRefPubMed

68.

Shearer J, Green C, Counsell CE, Zajicek JP (2011) The impact of motor and non-motor symptoms on health values in newly diagnosed idiopathic Parkinson’s disease. J Neurol 259(3):462–468CrossRefPubMed

69.

Chaudhuri KR, Schapira AHV (2009) Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol 8:464–474CrossRefPubMed

70.

Ngoga D, Kausar J, Harries A, Pall H, Mitchell R (2012) Deep brain stimulation reduces mortality in patients with severe Parkinson’s disease. Abstracts of the British Stereotactic and functional neurosurgery group annual meeting hosted by King’s College Hospital. Br J Neurosurg 26(4):585–593CrossRef

71.

Schuepbach WM, Rau J, Knudsen K, Volkmann J, Krack P, Timmermann L, Hälbig TD, Hesekamp H, Navarro SM, Meier N, Falk D, Mehdorn M, Paschen S, Maarouf M, Barbe MT, Fink GR, Kupsch A, Gruber D, Schneider GH, Seigneuret E, Kistner A, Chaynes P, Ory-Magne F, Brefel Courbon C, Vesper J, Schnitzler A, Wojtecki L, Houeto JL, Bataille B, Maltête D, Damier P, Raoul S, Sixel-Doering F, Hellwig D, Gharabaghi A, Krüger R, Pinsker MO, Amtage F, Régis JM, Witjas T, Thobois S, Mertens P, Kloss M, Hartmann A, Oertel WH, Post B, Speelman H, Agid Y, Schade-Brittinger C, Deuschl G, EARLYSTIM Study Group (2013) Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 368(7):610–622CrossRefPubMed

72.

Deuschl G, Schuepbach M, Knudsen K, Pinsker MO, Cornu P, Rau J, Agid Y, Schade-Brittinger C (2013) Stimulation of the subthalamic nucleus at an earlier disease stage of Parkinson’s disease: concept and standards of the EARLYSTIM study. Parkinsonism Relat Disord 19(1):56–61CrossRefPubMed

Title: The cost-effectiveness of deep brain stimulation in combination with best medical therapy, versus best medical therapy alone, in advanced Parkinson’s disease
Authors: Simon Eggington
Francesc Valldeoriola
K. Ray Chaudhuri
Keyoumars Ashkan
Elena Annoni
Günther Deuschl
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 1/2014
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-013-7148-z

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The cost-effectiveness of deep brain stimulation in combination with best medical therapy, versus best medical therapy alone, in advanced Parkinson’s disease

Abstract

Keynote webinar | Spotlight on medication adherence

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Abstract

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