Prospective comparative study on cost-effectiveness of subthalamic stimulation and best medical treatment in advanced Parkinson's disease.
نویسندگان
چکیده
This is an open, prospective, longitudinal study designed to compare two cohorts of patients with advanced Parkinson's disease during 1 year, one undergoing bilateral subthalamic stimulation (STN-DBS) and the other receiving the best medical treatment (BMT), with respect to the clinical effects observed and the medical expenses produced. Assessments were done by using clinical measures and a generic health related quality of life scale. A questionnaire was used to collect direct healthcare resources. As a measure of cost-effectiveness, we calculated life years gained adjusted by health-related quality of life (QALY) and the incremental cost-effectiveness ratio (ICER). Clinical and demographic variables of both groups were comparable at baseline. Total UPDRS scores improved from 50.5 +/- 3.6 to 28.5 +/- 3.8 in STN-DBS patients and worsened from 44.3 +/- 3.3 to 54.2 +/- 4 in the control group. Pharmacological costs in the operated patients were 3,799 +/- 940 euro, while in the BMT group the costs were 13,208 +/- 4,966 euro. Other medical costs were 1,280 +/- 720 euro in the STN-DBS group and 4,017 +/- 2,962 euro in BMT patients. Nondirect medical costs were 4,079 +/- 1,289 in operated patients and 2,787 +/- 1,209 euro in the BMT group. Mean QALYs were 0.7611 +/- 0.03 in STN-DBS and 0.5401 +/- 0.06 in BMT patients. In STN-DBS patients, the ICER needed to obtain an improvement of one point in the total UPDRS score was of 239.8 euro and the ICER/QALY was of 34,389 euro. Cost-effectiveness parameters were mostly related to the degree of clinical improvement and the reduction of pharmacological costs after STN-DBS. An ICER of 34,389 euro/QALY is within appropriate limits to consider subthalamic stimulation as an efficient therapy.
منابع مشابه
Anatomical situation of the subthalamic nucleus (STN) from midcommissural point (MCP) in Parkinson\'s disease patients underwent deep brain stimulation (DBS): an MRI targeting study
Abstract Introduction: It is demonstrated that the degree of clinical improvement in Parkinson's disease (PD) achieved by deep brain stimulation (DBS) is largely dependent on the accuracy of lead placement. In addition, individual variability in the situation of subthalamic nucleus (STN) is responsible for spatial inter-individual fluctuations of the real patient's target. Objecti...
متن کاملThe effect of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on the acoustic and prosodic features in patients with Parkinson’s disease: A study protocol for the first trial on Iranian patients
Background: The effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the voice features in Parkinson’s disease (PD) is controversial. No study has evaluated the voice features of PD underwent STN-DBS by the acoustic, perceptual, and patient-based assessments comprehensively. Furthermore, there is no study to investigate prosodic features before and after DBS in PD. The curren...
متن کاملEffect of bilateral deep brain stimulation of the subthalamic nucleus on freezing of gait in Parkinson's disease.
OBJECTIVE A prospective cohort study to evaluate the efficacy of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on freezing of gait (FOG) in patients with advanced Parkinson's disease. METHODS Patients (n = 10) with advanced Parkinson's disease were surgically implanted with microelectrodes to facilitate STN-DBS. Evaluations of FOG, motor function, activities of daily living ...
متن کاملEarly outcome of subthalamic nucleus deep brain stimulation (STN-DBS) in advanced parkinson disease in first trial of Iranian patients
Abstract Background: To improve the debilitating features of Parkinson disease (PD) different medical and surgical approaches are available. Subthalamic nucleus deep brain stimulation (STN-DBS) was appeared to be a promising method during last two decades. This study aimed to evaluate early motor outcomes of this procedure in first trial of Iranian patients . Methods: Thirty-seven...
متن کاملDeep brain stimulation for the treatment of Parkinson's disease: efficacy and safety.
Deep brain stimulation (DBS) surgery has become increasingly utilized in the treatment of advanced Parkinson's disease. Over the past decade, a number of studies have demonstrated that DBS is superior to best medical management in appropriately selected patients. The primary targets for DBS in Parkinson's disease include the subthalamic nucleus and the internal segment of the globus pallidus, b...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Movement disorders : official journal of the Movement Disorder Society
دوره 22 15 شماره
صفحات -
تاریخ انتشار 2007