Early Versus Delayed Bilateral Subthalamic Deep Brain Stimulation for Parkinson's Disease: A Decision Analysis
Identifieur interne : 002677 ( Main/Merge ); précédent : 002676; suivant : 002678Early Versus Delayed Bilateral Subthalamic Deep Brain Stimulation for Parkinson's Disease: A Decision Analysis
Auteurs : Alberto J. Espay [États-Unis] ; Jennifer E. Vaughan [États-Unis] ; Connie Marras [Canada] ; Rob Fowler [Canada] ; Mark H. Eckman [États-Unis]Source :
- Movement disorders [ 0885-3185 ] ; 2010.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Simulation.
English descriptors
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Abstract
The long-term benefits of subthalamic nucleus deep brain stimulation (STN DBS) applied earlier in the disease course, before significant disability accumulates, remain to be determined. We developed a Markov state transition decision analytic model to compare effectiveness in quality-adjusted life years (QALYs) of STN DBS applied to patients with PD at an "early" ("off time" 10-20%) versus "delayed" stage ("off time" >40%). A lifelong time horizon and societal perspective were assumed. Probabilities and rates were obtained from literature review; utilities were derived using the time trade-off technique and a computer-assisted utility assessment software tool applied to a cohort of 22 STN-DBS and 21 non-STN-DBS PD patients. Uncertainty was assessed through one- and two-way sensitivity analyses and probabilistic sensitivity analysis using second-order Monte Carlo simulations. Early STN DBS was preferred with a quality-adjusted life expectancy of 22.3 QALYs, a gain of 2.5 QALYs over those with delayed surgery (19.8 QALYs). Early STN DBS was preferred in 69% of 5,000 Monte Carlo simulations. Early surgery was robustly favored through most sensitivity analyses. Delayed STN DBS afforded greater QALYs when using utility estimates exclusively from non-STN-DBS patients and, for the entire group, if the rate of motor progression were to exceed 25% per year. Although decision modeling requires assumptions and simplifications, our exploratory analysis suggests that STN DBS performed in early PD may convey greater quality-adjusted life expectancy when compared to a delayed procedure. These findings support further evaluation of early STN DBS in a controlled clinical trial.
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Espay</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Vaughan, Jennifer E" sort="Vaughan, Jennifer E" uniqKey="Vaughan J" first="Jennifer E." last="Vaughan">Jennifer E. Vaughan</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Marras, Connie" sort="Marras, Connie" uniqKey="Marras C" first="Connie" last="Marras">Connie Marras</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Department of Medicine, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Fowler, Rob" sort="Fowler, Rob" uniqKey="Fowler R" first="Rob" last="Fowler">Rob Fowler</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Eckman, Mark H" sort="Eckman, Mark H" uniqKey="Eckman M" first="Mark H." last="Eckman">Mark H. Eckman</name><affiliation wicri:level="2"><inist:fA14 i1="05"><s1>Department of Internal Medicine, Division of General Internal Medicine, Center for Clinical Effectiveness, University of Cincinnati Medical Center</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Comparative study</term><term>Decision analysis</term><term>Deep brain stimulation</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Simulation</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Etude comparative</term><term>Analyse décision</term><term>Simulation</term><term>Stimulation cérébrale profonde</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Simulation</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The long-term benefits of subthalamic nucleus deep brain stimulation (STN DBS) applied earlier in the disease course, before significant disability accumulates, remain to be determined. We developed a Markov state transition decision analytic model to compare effectiveness in quality-adjusted life years (QALYs) of STN DBS applied to patients with PD at an "early" ("off time" 10-20%) versus "delayed" stage ("off time" >40%). A lifelong time horizon and societal perspective were assumed. Probabilities and rates were obtained from literature review; utilities were derived using the time trade-off technique and a computer-assisted utility assessment software tool applied to a cohort of 22 STN-DBS and 21 non-STN-DBS PD patients. Uncertainty was assessed through one- and two-way sensitivity analyses and probabilistic sensitivity analysis using second-order Monte Carlo simulations. Early STN DBS was preferred with a quality-adjusted life expectancy of 22.3 QALYs, a gain of 2.5 QALYs over those with delayed surgery (19.8 QALYs). Early STN DBS was preferred in 69% of 5,000 Monte Carlo simulations. Early surgery was robustly favored through most sensitivity analyses. Delayed STN DBS afforded greater QALYs when using utility estimates exclusively from non-STN-DBS patients and, for the entire group, if the rate of motor progression were to exceed 25% per year. Although decision modeling requires assumptions and simplifications, our exploratory analysis suggests that STN DBS performed in early PD may convey greater quality-adjusted life expectancy when compared to a delayed procedure. These findings support further evaluation of early STN DBS in a controlled clinical trial.</div></front></TEI><affiliations><list><country><li>Canada</li><li>États-Unis</li></country><region><li>Ohio</li><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="États-Unis"><region name="Ohio"><name sortKey="Espay, Alberto J" sort="Espay, Alberto J" uniqKey="Espay A" first="Alberto J." last="Espay">Alberto J. Espay</name></region><name sortKey="Eckman, Mark H" sort="Eckman, Mark H" uniqKey="Eckman M" first="Mark H." last="Eckman">Mark H. Eckman</name><name sortKey="Vaughan, Jennifer E" sort="Vaughan, Jennifer E" uniqKey="Vaughan J" first="Jennifer E." last="Vaughan">Jennifer E. Vaughan</name></country><country name="Canada"><noRegion><name sortKey="Marras, Connie" sort="Marras, Connie" uniqKey="Marras C" first="Connie" last="Marras">Connie Marras</name></noRegion><name sortKey="Fowler, Rob" sort="Fowler, Rob" uniqKey="Fowler R" first="Rob" last="Fowler">Rob Fowler</name><name sortKey="Marras, Connie" sort="Marras, Connie" uniqKey="Marras C" first="Connie" last="Marras">Connie Marras</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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