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Cost Effectiveness of Deep Brain Stimulation for Parkinson’s Disease: A Systematic Review

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Abstract

Background and Objective

Deep brain stimulation (DBS) is an established treatment for Parkinson’s disease (PD) in patients with advanced motor symptoms with an inadequate response to pharmacotherapies. Despite its effectiveness, the cost effectiveness of DBS remains a subject of debate. This systematic review aims to update and synthesize evidence on the cost effectiveness of DBS for PD.

Methods

To identify full economic evaluations that compared the cost effectiveness of DBS with other best medical treatments, a comprehensive search was conducted of the PubMed, Embase, Scopus, and Tufts Cost-Effective Analysis registry databases. The selected papers were systematically reviewed, and the results were summarized. For the quality appraisal, we used the modified economic evaluations bias checklist. The review protocol was a priori registered with PROSPERO, CRD42022345508.

Results

Sixteen identified cost-utility analyses that reported 19 comparisons on the use of DBS for PD were systematically reviewed. The studies were primarily conducted in high-income countries and employed Markov models. The costs considered were direct costs: surgical expenses, calibration, pulse generator replacement, and annual drug expenses. The majority of studies used country-specific thresholds. Fourteen comparisons from 12 studies reported on the cost effectiveness of DBS compared to best medical treatments. Eleven comparisons reported DBS as cost effective based on incremental cost-utility ratio results.

Conclusions

The cost effectiveness of DBS for PD varies by time horizon, costs considered, threshold utilized, and stage of PD progression. Standardizing approaches and comparing DBS with other treatments are needed for future research on effective PD management.

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Authors and Affiliations

  1. ICMR-National Institute of Epidemiology, Health Technology Assessment Resource Centre, ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India

    Akhil Sasidharan, Bhavani Shankara Bagepally & S Sajith Kumar

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  1. Akhil Sasidharan
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  2. Bhavani Shankara Bagepally
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  3. S Sajith Kumar
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Correspondence to Bhavani Shankara Bagepally.

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Funding

The Department of Health Research, Government of India funds the HTARC, ICMR-NIE grant no. T.11011/08/2017-HR(Part-1)/E-office-8025571 dated 27 November, 2019. The funders played no role in the study’s conception, execution, or manuscript preparation.

Conflict of interest

Akhil Sasidharan, Bhavani Shankara Bagepally, and S. Sajith Kumar have no conflicts of interest that are directly relevant to the content of this article.

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All relevant data and materials supporting the findings of this study are included in the submitted files. Additional data or materials, if required, can be obtained upon reasonable request by contacting the corresponding author.

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Author contributions

BSB and AS designed the study. BSB, AS, and SK conducted the literature search, screening, and data extraction. AS and SK performed the quality assessment, and AS performed the data synthesis. AS drafted the manuscript. All authors contributed to the interpretation of the results and critically revised the manuscript.

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Sasidharan, A., Bagepally, B.S. & Kumar, S. Cost Effectiveness of Deep Brain Stimulation for Parkinson’s Disease: A Systematic Review. Appl Health Econ Health Policy 22, 181–192 (2024). https://doi.org/10.1007/s40258-023-00848-y

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