Economic Evaluations Comparing Deep Brain Stimulation to Best Medical Therapy for Movement Disorders: A Meta-Analysis

Melissa Lannon (), Taylor Duda, Alexander Mastrolonardo, Ellissa Huang, Amanda Martyniuk, Forough Farrokhyar, Feng Xie, Mohit Bhandari, Suneil K. Kalia and Sunjay Sharma
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Melissa Lannon: McMaster University
Taylor Duda: McMaster University
Alexander Mastrolonardo: McMaster University
Ellissa Huang: McMaster University
Amanda Martyniuk: McMaster University
Forough Farrokhyar: McMaster University
Feng Xie: McMaster University
Mohit Bhandari: McMaster University
Suneil K. Kalia: University of Toronto
Sunjay Sharma: McMaster University

PharmacoEconomics, 2024, vol. 42, issue 1, No 5, 68 pages

Abstract: Abstract Background Movement disorders (Parkinson’s disease, essential tremor, primary dystonia) are a debilitating group of conditions that are progressive in nature. The mainstay of treatment is best medical therapy; however, a number of surgical therapies are available, including deep brain stimulation. Economic evaluations are an important aspect of evidence to inform decision makers regarding funding allocated to these therapies. Objective This systematic review and meta-analysis evaluated the cost effectiveness of including deep brain stimulation compared with best medical therapy for movement disorder indications in the adult population. Methods Ovid Medical Literature Analysis and Retrieval System Online, Embase, and Cochrane Central Register of Controlled Trials were queried. Only economic evaluations reporting incremental cost-effectiveness ratios for including deep brain stimulation versus best medical therapy for movement disorders were included. Studies were reviewed in duplicate for inclusion and data abstraction. Data were harmonized using the Consumer Price Index and Purchasing Power Parity to standardize values to 2022 US dollars. For inclusion in meta-analyses, studies were required to have sufficient data available to calculate an estimate of the incremental net benefit. Meta-analyses of pooled incremental net benefit based on the time horizon were performed. The study was registered at PROSPERO (CRD42022335436). Results There were 2190 studies reviewed, with 14 economic evaluations included following a title/abstract and full-text review. Only studies considering Parkinson’s disease were available for the meta-analysis. Quality of the identified studies was low, with moderate transferability to the American Healthcare System, and certainty of evidence was low. However, studies with a longer time horizon (15 years to lifetime) were found to have significant positive incremental net benefit (indicating cost effectiveness) for including deep brain stimulation with a mean difference of US$40,504.81 (95% confidence interval 2422.42–78,587.19). Conclusions Deep brain stimulation was cost effective for Parkinson’s disease when considered over the course of the patient’s remaining life after implantation. Trial Registration Clinical Trial Registration: PROSPERO (CRD42022335436).

Date: 2024
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DOI: 10.1007/s40273-023-01318-y

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