Early versus delayed bilateral subthalamic deep brain stimulation for parkinson's disease: a decision analysis.
Identifieur interne : 001729 ( PubMed/Curation ); précédent : 001728; suivant : 001730Early versus delayed bilateral subthalamic deep brain stimulation for parkinson's disease: a decision analysis.
Auteurs : Alberto J. Espay [États-Unis] ; Jennifer E. Vaughan ; Connie Marras ; Rob Fowler ; Mark H. EckmanSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2010.
English descriptors
- KwdEn :
- Aged, Antiparkinson Agents (therapeutic use), Cognition Disorders (etiology), Cognition Disorders (psychology), Decision Support Techniques, Deep Brain Stimulation (methods), Female, Humans, Male, Markov Chains, Middle Aged, Parkinson Disease (complications), Parkinson Disease (psychology), Parkinson Disease (therapy), Quality of Life, Subthalamic Nucleus (physiology), Time Factors, Treatment Outcome.
- MESH :
- chemical , therapeutic use : Antiparkinson Agents.
- complications : Parkinson Disease.
- etiology : Cognition Disorders.
- methods : Deep Brain Stimulation.
- physiology : Subthalamic Nucleus.
- psychology : Cognition Disorders, Parkinson Disease.
- therapy : Parkinson Disease.
- Aged, Decision Support Techniques, Female, Humans, Male, Markov Chains, Middle Aged, Quality of Life, Time Factors, Treatment Outcome.
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.
DOI: 10.1002/mds.23111
PubMed: 20629150
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Early versus delayed bilateral subthalamic deep brain stimulation for parkinson's disease: a decision analysis.</title><author><name sortKey="Espay, Alberto J" sort="Espay, Alberto J" uniqKey="Espay A" first="Alberto J" last="Espay">Alberto J. Espay</name><affiliation wicri:level="1"><nlm:affiliation>Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio 45267-0525, USA. alberto.espay@uc.edu</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio 45267-0525</wicri:regionArea></affiliation></author><author><name sortKey="Vaughan, Jennifer E" sort="Vaughan, Jennifer E" uniqKey="Vaughan J" first="Jennifer E" last="Vaughan">Jennifer E. Vaughan</name></author><author><name sortKey="Marras, Connie" sort="Marras, Connie" uniqKey="Marras C" first="Connie" last="Marras">Connie Marras</name></author><author><name sortKey="Fowler, Rob" sort="Fowler, Rob" uniqKey="Fowler R" first="Rob" last="Fowler">Rob Fowler</name></author><author><name sortKey="Eckman, Mark H" sort="Eckman, Mark H" uniqKey="Eckman M" first="Mark H" last="Eckman">Mark H. 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Espay</name><affiliation wicri:level="1"><nlm:affiliation>Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio 45267-0525, USA. alberto.espay@uc.edu</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio 45267-0525</wicri:regionArea></affiliation></author><author><name sortKey="Vaughan, Jennifer E" sort="Vaughan, Jennifer E" uniqKey="Vaughan J" first="Jennifer E" last="Vaughan">Jennifer E. Vaughan</name></author><author><name sortKey="Marras, Connie" sort="Marras, Connie" uniqKey="Marras C" first="Connie" last="Marras">Connie Marras</name></author><author><name sortKey="Fowler, Rob" sort="Fowler, Rob" uniqKey="Fowler R" first="Rob" last="Fowler">Rob Fowler</name></author><author><name sortKey="Eckman, Mark H" sort="Eckman, Mark H" uniqKey="Eckman M" first="Mark H" last="Eckman">Mark H. Eckman</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="eISSN">1531-8257</idno><imprint><date when="2010" type="published">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Antiparkinson Agents (therapeutic use)</term><term>Cognition Disorders (etiology)</term><term>Cognition Disorders (psychology)</term><term>Decision Support Techniques</term><term>Deep Brain Stimulation (methods)</term><term>Female</term><term>Humans</term><term>Male</term><term>Markov Chains</term><term>Middle Aged</term><term>Parkinson Disease (complications)</term><term>Parkinson Disease (psychology)</term><term>Parkinson Disease (therapy)</term><term>Quality of Life</term><term>Subthalamic Nucleus (physiology)</term><term>Time Factors</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiparkinson Agents</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Cognition Disorders</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Subthalamic Nucleus</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Cognition Disorders</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Decision Support Techniques</term><term>Female</term><term>Humans</term><term>Male</term><term>Markov Chains</term><term>Middle Aged</term><term>Quality of Life</term><term>Time Factors</term><term>Treatment Outcome</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><pubmed><MedlineCitation Owner="NLM" Status="MEDLINE"><PMID Version="1">20629150</PMID><DateCreated><Year>2010</Year><Month>08</Month><Day>02</Day></DateCreated><DateCompleted><Year>2010</Year><Month>12</Month><Day>02</Day></DateCompleted><DateRevised><Year>2013</Year><Month>06</Month><Day>19</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1531-8257</ISSN><JournalIssue CitedMedium="Internet"><Volume>25</Volume><Issue>10</Issue><PubDate><Year>2010</Year><Month>Jul</Month><Day>30</Day></PubDate></JournalIssue><Title>Movement disorders : official journal of the Movement Disorder Society</Title><ISOAbbreviation>Mov. Disord.</ISOAbbreviation></Journal><ArticleTitle>Early versus delayed bilateral subthalamic deep brain stimulation for parkinson's disease: a decision analysis.</ArticleTitle><Pagination><MedlinePgn>1456-63</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1002/mds.23111</ELocationID><Abstract><AbstractText>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. 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