Prospective comparative study on cost‐effectiveness of subthalamic stimulation and best medical treatment in advanced Parkinson's disease
Identifieur interne : 000D51 ( Main/Corpus ); précédent : 000D50; suivant : 000D52Prospective comparative study on cost‐effectiveness of subthalamic stimulation and best medical treatment in advanced Parkinson's disease
Auteurs : Francesc Valldeoriola ; Ossama Morsi ; Eduardo Tolosa ; Jordi Rumià ; Maria José Martí ; Pablo Martínez-MartínSource :
- Movement Disorders [ 0885-3185 ] ; 2007-11-15.
English descriptors
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. © 2007 Movement Disorder Society
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DOI: 10.1002/mds.21652
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ISTEX:AA145911C0E78474945B5EDF22BB43F94277DD1FLe document en format XML
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Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2007-11-15">2007-11-15</date><biblScope unit="volume">22</biblScope><biblScope unit="issue">15</biblScope><biblScope unit="page" from="2183">2183</biblScope><biblScope unit="page" to="2191">2191</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">AA145911C0E78474945B5EDF22BB43F94277DD1F</idno><idno type="DOI">10.1002/mds.21652</idno><idno type="ArticleID">MDS21652</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Parkinson disease</term><term>QALY</term><term>cost‐efficacy</term><term>expenses</term><term>subthalamic stimulation</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><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. © 2007 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Francesc Valldeoriola MD,PhD</name><affiliations><json:string>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Ossama Morsi MD</name><affiliations><json:string>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Eduardo Tolosa MD,PhD</name><affiliations><json:string>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Jordi Rumià MD</name><affiliations><json:string>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Maria José Martí MD,PhD</name><affiliations><json:string>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</json:string></affiliations></json:item><json:item><name>Pablo Martínez‐Martín MD,PhD</name><affiliations><json:string>Institute of Health Carlos III, National Center for Epidemiology, Madrid, Spain</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Parkinson disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subthalamic stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cost‐efficacy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>expenses</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>QALY</value></json:item></subject><articleId><json:string>MDS21652</json:string></articleId><language><json:string>eng</json:string></language><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. 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Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2007-11-15"></date><biblScope unit="volume">22</biblScope><biblScope unit="issue">15</biblScope><biblScope unit="page" from="2183">2183</biblScope><biblScope unit="page" to="2191">2191</biblScope></imprint></monogr><idno type="istex">AA145911C0E78474945B5EDF22BB43F94277DD1F</idno><idno type="DOI">10.1002/mds.21652</idno><idno type="ArticleID">MDS21652</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2007</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>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. 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type="organization"><unparsedAffiliation>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="ES" type="organization"><unparsedAffiliation>Institute of Health Carlos III, National Center for Epidemiology, Madrid, Spain</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Parkinson disease</keyword><keyword xml:id="kwd2">subthalamic stimulation</keyword><keyword xml:id="kwd3">cost‐efficacy</keyword><keyword xml:id="kwd4">expenses</keyword><keyword xml:id="kwd5">QALY</keyword></keywordGroup><fundingInfo><fundingAgency>Fellowship for Specific Training in Movement Disorders from the Spanish Neurological Society</fundingAgency></fundingInfo><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>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. © 2007 Movement Disorder Society</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Prospective comparative study on cost‐effectiveness of subthalamic stimulation and best medical treatment in advanced Parkinson's disease</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Cost‐Effectiveness of STN‐DBS and BMT in Advanced PD</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Prospective comparative study on cost‐effectiveness of subthalamic stimulation and best medical treatment in advanced Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">Francesc</namePart><namePart type="family">Valldeoriola</namePart><namePart type="termsOfAddress">MD,PhD</namePart><affiliation>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</affiliation><description>Correspondence: Service of Neurology, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ossama</namePart><namePart type="family">Morsi</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Eduardo</namePart><namePart type="family">Tolosa</namePart><namePart type="termsOfAddress">MD,PhD</namePart><affiliation>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jordi</namePart><namePart type="family">Rumià</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Maria José</namePart><namePart type="family">Martí</namePart><namePart type="termsOfAddress">MD,PhD</namePart><affiliation>Hospital Clinic, Institut de Neurociències Universitat de Barcelona, Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pablo</namePart><namePart type="family">Martínez‐Martín</namePart><namePart type="termsOfAddress">MD,PhD</namePart><affiliation>Institute of Health Carlos III, National Center for Epidemiology, Madrid, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2007-11-15</dateIssued><dateCaptured encoding="w3cdtf">2006-11-08</dateCaptured><dateValid encoding="w3cdtf">2007-06-05</dateValid><copyrightDate encoding="w3cdtf">2007</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">3</extent><extent unit="tables">5</extent><extent unit="references">36</extent><extent unit="words">5543</extent></physicalDescription><abstract 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. © 2007 Movement Disorder Society</abstract><note type="funding">Fellowship for Specific Training in Movement Disorders from the Spanish Neurological Society</note><subject lang="en"><genre>Keywords</genre><topic>Parkinson disease</topic><topic>subthalamic stimulation</topic><topic>cost‐efficacy</topic><topic>expenses</topic><topic>QALY</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title><subTitle>Official Journal of the Movement Disorder Society</subTitle></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><genre type="Journal">journal</genre><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>22</number></detail><detail type="issue"><caption>no.</caption><number>15</number></detail><extent unit="pages"><start>2183</start><end>2191</end><total>9</total></extent></part></relatedItem><identifier type="istex">AA145911C0E78474945B5EDF22BB43F94277DD1F</identifier><identifier type="DOI">10.1002/mds.21652</identifier><identifier type="ArticleID">MDS21652</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2007 Movement Disorder Society</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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