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Journal of Neurology

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01-12-2019 | Obsessive-Compulsive Disorder | Original Communication

Economic evaluation of deep-brain stimulation for Tourette’s syndrome: an initial exploration

Authors: Tho T. H. Dang, David Rowell, Jacki Liddle, Terry Coyne, Peter Silburn, Luke B. Connelly

Published in: Journal of Neurology | Issue 12/2019

Abstract

Background

Deep-brain stimulation (DBS) can be effective in controlling medically intractable symptoms of Tourette’s syndrome (TS). There is no evidence to date, though, of the potential cost-effectiveness of DBS for this indication.

Objective

To provide the first estimates of the likely cost-effectiveness of DBS in the treatment of severe TS.

Methods

We conducted a cost-utility analysis using clinical data from 17 Australian patients receiving DBS. Direct medical costs for DBS using non-rechargeable and rechargeable batteries and for the alternative best medical treatment (BMT), and health utilities for BMT were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated using a Markov models with a 10-year time horizon and 5% discount rate.

Results

DBS increased quality-adjusted life year (QALY) gained from 2.76 to 4.60 over a 10-year time horizon. The ICER for DBS with non-rechargeable (rechargeable) batteries, compared to BMT, was A$33,838 (A$15,859) per QALY. The ICER estimates are sensitive to DBS costs and selected time horizon.

Conclusions

Our study indicates that DBS may be a cost-effective treatment for severe TS, based on the very limited clinical data available and under particular assumptions. While the limited availability of data presents a challenge, we also conduct sensitivity analyses to test the robustness of the results to the assumptions used in the analysis. We nevertheless recommend the implementation of randomised controlled trials that collect a comprehensive range of costs and the use of a widely accepted health-related quality of life instrument to enable more definitive statements about the cost-effectiveness of DBS for TS.

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Title: Economic evaluation of deep-brain stimulation for Tourette’s syndrome: an initial exploration
Authors: Tho T. H. Dang
David Rowell
Jacki Liddle
Terry Coyne
Peter Silburn
Luke B. Connelly
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Obsessive-Compulsive Disorder
Tourette Syndrome
Tourette Syndrome
Published in: Journal of Neurology / Issue 12/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09521-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Economic evaluation of deep-brain stimulation for Tourette’s syndrome: an initial exploration

Abstract

Background

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

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