Cost-Effectiveness Analysis of Deep Brain Stimulation for Parkinson Disease in Taiwan

Jean Ching Yuan Fann, Kai Chieh Chang, Amy Ming Fang Yen, Sam Li Sheng Chen, Sherry Yueh Hsia Chiu, Hsiu Hsi Chen, Horng Huei Liou

Research output: Contribution to journalArticle

Abstract

Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective therapy for Parkinson disease (PD). However, cost-effectiveness analysis is required because most patients are older adults and decision makers must therefore consider whether the long-term effectiveness outweighs the initial cost. Methods: A Markov decision model was constructed on the basis of a societal perspective. The Hoehn and Yahr scale and Unified PD Rating Scale motor score were used in the polytomous logistic regression model. Markov Chain Monte Carlo simulation was used to initiate the probabilistic cost-effectiveness analysis. Results: The life-year gained (LYG) in the STN-DBS group and medication group was, respectively, 2.937 and 2.632 years at the 3-year follow-up and 7.417 and 5.971 years at the 10-year follow-up. The quality-adjusted life-year (QALY) gained in the STN-DBS and medication groups was, respectively, 1.739 and 1.220 at the 3-year follow-up and 4.189 and 2.88 at the 10-year follow-up. The incremental cost-effectiveness ratio of STN-DBS compared with medication was $147,065 per LYG and $123,436 per QALY gained at the 3-year follow-up and $36,833 and $69,033 at the 10-year follow-up, respectively. STN-DBS is an optimal strategy when the willingness to pay is $150,000 per LYG and over $90,000 per QALY gained in 3 years and when the willingness to pay is over $38,000 per LYG and over $41,000 per QALY gained in 10 years. Conclusions: This study provided data comparing STN-DBS and medical treatment for PD with respect to LYG and QALY gained. STN-DBS was more cost-effective in terms of LYG and QALY gained according to the current gross domestic product of Taiwan.

Original languageEnglish
Pages (from-to)e459-e468
JournalWorld Neurosurgery
Volume138
DOIs
Publication statusPublished - Jun 2020

Keywords

  • Deep brain stimulation of the subthalamic nucleus
  • Markov decision model
  • Parkinson disease
  • Probabilistic cost-effectiveness analysis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Cost-Effectiveness Analysis of Deep Brain Stimulation for Parkinson Disease in Taiwan'. Together they form a unique fingerprint.

  • Cite this

    Fann, J. C. Y., Chang, K. C., Yen, A. M. F., Chen, S. L. S., Chiu, S. Y. H., Chen, H. H., & Liou, H. H. (2020). Cost-Effectiveness Analysis of Deep Brain Stimulation for Parkinson Disease in Taiwan. World Neurosurgery, 138, e459-e468. https://doi.org/10.1016/j.wneu.2020.02.150