Hacker Mallory L, Currie Amanda D, Molinari Anna L, Turchan Maxim, Millan Sarah M, Heusinkveld Lauren E, Roach Jonathon, Konrad Peter E, Davis Thomas L, Neimat Joseph S, Phibbs Fenna T, Hedera Peter, Byrne Daniel W, Charles David
Department of Neurology, Vanderbilt University, Medical Center North, Nashville, TN, USA.
Department of Neurosurgery, Vanderbilt University, Village at Vanderbilt, Nashville, TN, USA.
J Parkinsons Dis. 2016;6(1):125-31. doi: 10.3233/JPD-150712.
Subthalamic nucleus deep brain stimulation (STN-DBS) is well-known to reduce medication burden in advanced stage Parkinson's disease (PD). Preliminary data from a prospective, single blind, controlled pilot trial demonstrated that early stage PD subjects treated with STN-DBS also required less medication than those treated with optimal drug therapy (ODT).
The purpose of this study was to analyze medication cost and utilization from the pilot trial of DBS in early stage PD and to project 10 year medication costs.
Medication data collected at each visit were used to calculate medication costs. Medications were converted to levodopa equivalent daily dose, categorized by medication class, and compared. Medication costs were projected to advanced stage PD, the time when a typical patient may be offered DBS.
Medication costs increased 72% in the ODT group and decreased 16% in the DBS+ODT group from baseline to 24 months. This cost difference translates into a cumulative savings for the DBS+ODT group of $7,150 over the study period. Projected medication cost savings over 10 years reach $64,590. Additionally, DBS+ODT subjects were 80% less likely to require polypharmacy compared with ODT subjects at 24 months (p < 0.05; OR = 0.2; 95% CI: 0.04-0.97).
STN-DBS in early PD reduced medication cost over the two-year study period. DBS may offer substantial long-term reduction in medication cost by maintaining a simplified, low dose medication regimen. Further study is needed to confirm these findings, and the FDA has approved a pivotal, multicenter clinical trial evaluating STN-DBS in early PD.
众所周知，丘脑底核深部脑刺激术（STN-DBS）可减轻晚期帕金森病（PD）患者的药物负担。一项前瞻性、单盲、对照试验的初步数据表明，接受STN-DBS治疗的早期PD患者比接受最佳药物治疗（ODT）的患者所需药物也更少。
本研究旨在分析早期PD患者DBS试验中的药物成本和使用情况，并预测10年的药物成本。
每次随访收集的药物数据用于计算药物成本。将药物换算为左旋多巴等效日剂量，按药物类别分类并进行比较。将药物成本推算至晚期PD阶段，即典型患者可能接受DBS治疗的时间。
从基线到24个月，ODT组的药物成本增加了72%，而DBS+ODT组降低了16%。这一成本差异意味着在研究期间DBS+ODT组累计节省7150美元。预计10年的药物成本节省可达64590美元。此外，在24个月时，与ODT组患者相比，DBS+ODT组患者需要联合用药的可能性降低了80%（p<0.05；OR=0.2；95%CI：0.04-0.97）。
在为期两年的研究期内，早期PD患者的STN-DBS降低了药物成本。通过维持简化的低剂量药物治疗方案，DBS可能会大幅降低长期药物成本。需要进一步研究来证实这些发现，并且美国食品药品监督管理局（FDA）已批准一项关键性的多中心临床试验，评估早期PD患者的STN-DBS。
