Economic analysis of deep brain stimulation in Parkinson’s disease: systematic review of the literature

Abstract Background Parkinson’s disease (PD) is a chronic multifaceted neurodegenerative disorder of adult onset that affects quality of life and places a burden on patients, caregivers and society. In early disease, dopaminergic therapy improves motor symptoms but as the disease progresses, symptoms tend to increase in frequency and severity even with best medical treatment (BMT). Deep brain stimulation (DBS) becomes an option for certain patients, but cost becomes an important issue. Objective We performed a systematic review of the literature of economic studies of the use of DBS in patients with PD, including costs studies or economic evaluations expressed as cost per improvement in quality life, decrease in dose of pharmacological treatments and the decrease of caregiver burden. Methods We reviewed the following databases: Medline/Pubmed, Embase, Cochrane Database of Systematic Reviews, LILACS, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform ICTRP portal and ClinicalTrials.gov from 1980 to 2015. Costs have been converted and/or adjusted to 2016 US dollars (USD$). Results Nine studies were identified. The average cost of DBS for a patient with PD in five years is USD$ 186,244. The quality-adjusted life year (QALY) was higher in DBS compared to BMT after at least two years of treatment, with an average incremental cost utility ratio (ICUR) of USD$ 41,932 per additional QALY gained. Costs in the first year are higher with DBS due to direct costs related to the surgical procedure, the device, and the more frequent controls. Studies show better results with a longer time horizon (up to 5 years). Conclusion DBS is a cost-effective intervention for patients with advanced PD but has a high initial cost compared to BMT. However, DBS reduces pharmacological treatment costs and should also reduce direct, indirect and social costs of PD on the long term.