Department of Neurological Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.
Mov Disord. 2011 Jul;26(8):1422-7. doi: 10.1002/mds.23787. Epub 2011 Jun 14.
Deep brain stimulation of the subthalamic nucleus is the standard of care for treating medically intractable Parkinson's disease. Although the adjunct of microelectrode recording improves the targeting accuracy of subthalamic nucleus deep brain stimulation in comparison with image guidance alone, there has been no investigation of the financial cost of intraoperative microelectrode recording. This study was performed to address this issue. A comprehensive literature search of large subthalamic nucleus deep brain stimulation series (minimum, 75 patients) was performed, revealing a mean operating room time of 223.83 minutes for unilateral and 279.79 minutes for simultaneous bilateral implantation. The baseline operating room time was derived from the published operating room time for subthalamic nucleus deep brain stimulation without microelectrode recording. The total cost (operating room, anesthesia, neurosurgery) was then calculated based on hospitals geographically representative of the entire United States. The average cost for subthalamic nucleus deep brain stimulation implantation with microelectrode recording per patient is $26,764.79 for unilateral, $33,481.43 for simultaneous bilateral, and $53,529.58 for staged bilateral. For unilateral implantation, the cost of microelectrode recording is $19,461.75, increasing the total cost by 267%. For simultaneous bilateral implantation, microelectrode recording costs $20,535.98, increasing the total cost by 159%. For staged bilateral implantation, microelectrode recording costs $38,923.49, increasing the total cost by 267%. Microelectrode recording more than doubles the cost of subthalamic nucleus deep brain stimulation for Parkinson's disease and more than triples the cost for unilateral and staged bilateral procedures. The cost burden of microelectrode recording to subthalamic nucleus deep brain stimulation requires the clinical efficacy of microelectrode recording to be proven in a prospective evidence-based manner in order to curtail the potential for excessive financial burden to the health care system.
丘脑底核深部脑刺激是治疗药物难治性帕金森病的标准治疗方法。虽然与单独的图像引导相比，微电极记录可提高丘脑底核深部脑刺激的靶向准确性，但尚未研究术中微电极记录的财务成本。本研究旨在解决这一问题。对大型丘脑底核深部脑刺激系列（最低 75 例患者）进行了全面的文献检索，结果显示单侧丘脑底核深部脑刺激的平均手术室时间为 223.83 分钟，同期双侧植入的手术室时间为 279.79 分钟。基线手术室时间来自已发表的无微电极记录的丘脑底核深部脑刺激手术室时间。然后根据美国各地具有代表性的医院计算总费用（手术室、麻醉、神经外科）。有微电极记录的丘脑底核深部脑刺激植入术的平均每位患者费用为单侧 26764.79 美元，同期双侧 33481.43 美元，分期双侧 53529.58 美元。对于单侧植入，微电极记录的成本为 19461.75 美元，使总费用增加了 267%。对于同期双侧植入，微电极记录的成本为 20535.98 美元，使总费用增加了 159%。对于分期双侧植入，微电极记录的成本为 38923.49 美元，使总费用增加了 267%。微电极记录使帕金森病患者的丘脑底核深部脑刺激成本增加了一倍以上，使单侧和分期双侧手术的成本增加了两倍以上。为了控制对医疗保健系统的潜在过度财务负担，需要以循证的前瞻性方式证明微电极记录对丘脑底核深部脑刺激的临床疗效。
