Cost‐utility analysis of deep brain stimulation surgery plus best medical therapy versus best medical therapy in patients with Parkinson's: Economic evaluation alongside the PD SURG trial

McIntosh, Emma; Gray, Alastair; Daniels, Jane; Gill, Steven; Ives, Natalie; Jenkinson, Crispin; Mitchell, Rosalind; Pall, Hardev; Patel, Smitaa; Quinn, Niall; Rick, Caroline; Wheatley, Keith; Williams, Adrian; on behalf of The PD SURG Collaborators Group

Abstract

Introduction

Williams and colleagues reported that DBS surgery for patients with advanced PD improves motor function and quality of life compared to best medical therapy alone at 1 year, but with surgery‐related side effects in a minority. This article reports on the economic evaluation alongside this trial.

Methods

Detailed resource use and quality of life over 12 months after randomization was obtained from the trial reported by Williams and colleagues. Outcomes were measured using the EQ‐5D and quality‐adjusted life years calculated.

Results

Year 1 costs for surgery were significantly higher than in best medical therapy, at £19,069 compared to £9,813, a difference of £9,256 (95% confidence interval [CI]: £7,625, £10,887). There was a small, significant gain in utility at 1 year but a statistically insignificant gain of 0.02 quality‐adjusted life years (95% CI: −0.015, 0.05) in the surgical arm. The incremental cost per quality‐adjusted life year of surgery at 1 year was £468,528. Extrapolation reveals that after 5 years, this ratio is likely to reduce to £45,180, but subsequently rise to £70,537 at 10 years owing to the increased probability of battery replacements (and re‐replacements) beyond 5 years.

Conclusion

In this patient group, DBS is not cost‐effective at 1 year. Extrapolation, however, reveals an increasing likelihood of cost‐effectiveness up to 5 years and reducing cost‐effectiveness between 5 and 10 years. These models are sensitive to assumptions about future costs and quality‐adjusted life years gained.

Citation

McIntosh, E., Gray, A., Daniels, J., Gill, S., Ives, N., Jenkinson, C., Mitchell, R., Pall, H., Patel, S., Quinn, N., Rick, C., Wheatley, K., Williams, A., & on behalf of The PD SURG Collaborators Group. (2016). Cost‐utility analysis of deep brain stimulation surgery plus best medical therapy versus best medical therapy in patients with Parkinson's: Economic evaluation alongside the PD SURG trial. Movement Disorders, 31(8), 1173-1182. https://doi.org/10.1002/mds.26423

• Journal Article Type: Article
• Acceptance Date: Jul 13, 2015
• Online Publication Date: Feb 5, 2016
• Publication Date: 2016-08
• Deposit Date: Jun 27, 2019
• Journal: Movement Disorders
• Print ISSN: 0885-3185
• Electronic ISSN: 1531-8257
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 31
• Issue: 8
• Pages: 1173-1182
• DOI: https://doi.org/10.1002/mds.26423
• Keywords: Neurology; Clinical Neurology
• Public URL: https://nottingham-repository.worktribe.com/output/2235534
• Publisher URL: https://onlinelibrary.wiley.com/doi/full/10.1002/mds.26423
• Additional Information: This is the peer reviewed version of the following article: McIntosh, E. , Gray, A. , Daniels, J. , Gill, S. , Ives, N. , Jenkinson, C. , Mitchell, R. , Pall, H. , Patel, S. , Quinn, N. , Rick, C. , Wheatley, K. , Williams, A ... (2016), Cost‐utility analysis of deep brain stimulation surgery plus best medical therapy versus best medical therapy in patients with Parkinson's: Economic evaluation alongside the PD SURG trial. Mov Disord., 31: 1173-1182. doi:10.1002/mds.26423 which has been published in final form at https://doi.org/10.1002/mds.26423. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.