Prospective Comparative Study on Cost-Effectiveness of Subthalamic Stimulation and Best Medical Treatment in Advanced Parkinson's Disease
Identifieur interne : 004102 ( Main/Merge ); précédent : 004101; suivant : 004103Prospective Comparative Study on Cost-Effectiveness of Subthalamic Stimulation and Best Medical Treatment in Advanced Parkinson's Disease
Auteurs : Francesc Valldeoriola [Espagne] ; Ossama Morsi [Espagne] ; Eduardo Tolosa [Espagne] ; Jordi Rumia [Espagne] ; Maria José Marti [Espagne] ; Pablo Martinez-Martin [Espagne]Source :
- Movement disorders [ 0885-3185 ] ; 2007.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Prospective.
English descriptors
- KwdEn :
Abstract
This is an open, prospective, longitudinal study designed to compare two cohorts of patients with advanced Parkinson's disease during 1 year, one undergoing bilateral subthalamic stimulation (STN-DBS) and the other receiving the best medical treatment (BMT), with respect to the clinical effects observed and the medical expenses produced. Assessments were done by using clinical measures and a generic health related quality of life scale. A questionnaire was used to collect direct healthcare resources. As a measure of cost-effectiveness, we calculated life years gained adjusted by health-related quality of life (QALY) and the incremental cost-effectiveness ratio (ICER). Clinical and demographic variables of both groups were comparable at baseline. Total UPDRS scores improved from 50.5 ± 3.6 to 28.5 ± 3.8 in STN-DBS patients and worsened from 44.3 ± 3.3 to 54.2 ± 4 in the control group. Pharmacological costs in the operated patients were 3,799 ± 940∈, while in the BMT group the costs were 13,208 ± 4,966∈. Other medical costs were 1,280 ± 720∈ in the STN-DBS group and 4,017 ± 2,962∈ in BMT patients. Nondirect medical costs were 4,079 ± 1,289 in operated patients and 2,787 ± 1,209∈ in the BMT group. Mean QALYs were 0.7611 ± 0.03 in STN-DBS and 0.5401 ± 0.06 in BMT patients. In STN-DBS patients, the ICER needed to obtain an improvement of one point in the total UPDRS score was of 239.8∈ and the ICER/QALY was of 34,389∈. Cost-effectiveness parameters were mostly related to the degree of clinical improvement and the reduction of pharmacological costs after STN-DBS. An ICER of 34,389∈/QALY is within appropriate limits to consider subthalamic stimulation as an efficient therapy.
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<front><div type="abstract" xml:lang="en">This is an open, prospective, longitudinal study designed to compare two cohorts of patients with advanced Parkinson's disease during 1 year, one undergoing bilateral subthalamic stimulation (STN-DBS) and the other receiving the best medical treatment (BMT), with respect to the clinical effects observed and the medical expenses produced. Assessments were done by using clinical measures and a generic health related quality of life scale. A questionnaire was used to collect direct healthcare resources. As a measure of cost-effectiveness, we calculated life years gained adjusted by health-related quality of life (QALY) and the incremental cost-effectiveness ratio (ICER). Clinical and demographic variables of both groups were comparable at baseline. Total UPDRS scores improved from 50.5 ± 3.6 to 28.5 ± 3.8 in STN-DBS patients and worsened from 44.3 ± 3.3 to 54.2 ± 4 in the control group. Pharmacological costs in the operated patients were 3,799 ± 940∈, while in the BMT group the costs were 13,208 ± 4,966∈. Other medical costs were 1,280 ± 720∈ in the STN-DBS group and 4,017 ± 2,962∈ in BMT patients. Nondirect medical costs were 4,079 ± 1,289 in operated patients and 2,787 ± 1,209∈ in the BMT group. Mean QALYs were 0.7611 ± 0.03 in STN-DBS and 0.5401 ± 0.06 in BMT patients. In STN-DBS patients, the ICER needed to obtain an improvement of one point in the total UPDRS score was of 239.8∈ and the ICER/QALY was of 34,389∈. Cost-effectiveness parameters were mostly related to the degree of clinical improvement and the reduction of pharmacological costs after STN-DBS. An ICER of 34,389∈/QALY is within appropriate limits to consider subthalamic stimulation as an efficient therapy.</div>
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