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

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.

• Authors: Tho T H Dang, David Rowell, Jacki Liddle, Terry Coyne, Peter Silburn, Luke B Connelly
• Journal: Journal of neurology (J Neurol) Vol. 266 Issue 12 Pg. 2997-3008 (Dec 2019) ISSN: 1432-1459 [Electronic] Germany
• PMID: 31485722 (Publication Type: Evaluation Study, Journal Article)

Topics

• Cost-Benefit Analysis
• Deep Brain Stimulation (economics, instrumentation)
• Humans
• Markov Chains
• Quality-Adjusted Life Years
• Tourette Syndrome (economics, therapy)