| アブストラクト | BACKGROUND: Parkinson's disease (PD) is a debilitating illness associated with considerable impairment of quality of life and substantial costs to health care systems. Deep brain stimulation (DBS) is an established surgical treatment option for some patients with advanced PD. The EARLYSTIM trial has recently demonstrated its clinical benefit also in patients with early motor complications. We sought to evaluate the cost-effectiveness of DBS, compared to best medical therapy (BMT), among PD patients with early onset of motor complications, from a United Kingdom (UK) payer perspective. METHODS: We developed a Markov model to represent the progression of PD as rated using the Unified Parkinson's Disease Rating Scale (UPDRS) over time in patients with early PD. Evidence sources were a systematic review of clinical evidence; data from the EARLYSTIM study; and a UK Clinical Practice Research Datalink (CPRD) dataset including DBS patients. A mapping algorithm was developed to generate utility values based on UPDRS data for each intervention. The cost-effectiveness was expressed as the incremental cost per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were undertaken to explore the effect of parameter uncertainty. RESULTS: Over a 15-year time horizon, DBS was predicted to lead to additional mean cost per patient of pound26,799 compared with BMT ( pound73,077/patient versus pound46,278/patient) and an additional mean 1.35 QALYs (6.69 QALYs versus 5.35 QALYs), resulting in an incremental cost-effectiveness ratio of pound19,887 per QALY gained with a 99% probability of DBS being cost-effective at a threshold of pound30,000/QALY. One-way sensitivity analyses suggested that the results were not significantly impacted by plausible changes in the input parameter values. CONCLUSION: These results indicate that DBS is a cost-effective intervention in PD patients with early motor complications when compared with existing interventions, offering additional health benefits at acceptable incremental cost. This supports the extended use of DBS among patients with early onset of motor complications. |
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| 投稿者 | Fundament, Tomasz; Eldridge, Paul R; Green, Alexander L; Whone, Alan L; Taylor, Rod S; Williams, Adrian C; Schuepbach, W M Michael |
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| 組織名 | HTA Consulting, Krakow, Poland.;The Walton Centre NHS Foundation Trust and Liverpool University, Liverpool,;United Kingdom.;Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United;Kingdom.;Bristol Brain Centre, Southmead Hospital, Bristol, United Kingdom.;University of Exeter Medical School, Exeter, United Kingdom.;University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.;Movement Disorders Center, Department of Neurology, Bern University Hospital and;University of Bern, Bern, Switzerland.;Assistance Publique Hopitaux de Paris, Centre d'Investigation Clinique 9503,;Institut du Cerveau et de la Moelle epiniere, Departement de Neurologie,;Universite Pierre et Marie Curie-Paris 6 et INSERM, CHU Pitie-Salpetriere, Paris,;France. |
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