Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia.
Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia.
J Neurol. 2019 Dec;266(12):2997-3008. doi: 10.1007/s00415-019-09521-8. Epub 2019 Sep 4.
Deep-brain stimulation (DBS) can be effective in controlling medically intractable symptoms of Tourette's syndrome (TS). There is no evidence to date, though, of the potential cost-effectiveness of DBS for this indication.
To provide the first estimates of the likely cost-effectiveness of DBS in the treatment of severe TS.
We conducted a cost-utility analysis using clinical data from 17 Australian patients receiving DBS. Direct medical costs for DBS using non-rechargeable and rechargeable batteries and for the alternative best medical treatment (BMT), and health utilities for BMT were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated using a Markov models with a 10-year time horizon and 5% discount rate.
DBS increased quality-adjusted life year (QALY) gained from 2.76 to 4.60 over a 10-year time horizon. The ICER for DBS with non-rechargeable (rechargeable) batteries, compared to BMT, was A$33,838 (A$15,859) per QALY. The ICER estimates are sensitive to DBS costs and selected time horizon.
Our study indicates that DBS may be a cost-effective treatment for severe TS, based on the very limited clinical data available and under particular assumptions. While the limited availability of data presents a challenge, we also conduct sensitivity analyses to test the robustness of the results to the assumptions used in the analysis. We nevertheless recommend the implementation of randomised controlled trials that collect a comprehensive range of costs and the use of a widely accepted health-related quality of life instrument to enable more definitive statements about the cost-effectiveness of DBS for TS.
深部脑刺激（DBS）可有效控制药物难治性妥瑞氏综合征（TS）的症状。然而，目前尚无证据表明 DBS 对该适应症具有潜在的成本效益。
提供 DBS 治疗严重 TS 的成本效益的首次估计。
我们使用 17 名接受 DBS 的澳大利亚患者的临床数据进行了成本效用分析。DBS 的直接医疗费用（使用不可充电和可充电电池）和替代最佳医疗（BMT），以及 BMT 的健康效用，均来自文献。使用具有 10 年时间范围和 5％折扣率的马尔可夫模型估算增量成本效益比（ICER）。
DBS 将 10 年内的质量调整生命年（QALY）从 2.76 增加到 4.60。与 BMT 相比，DBS 使用不可充电（可充电）电池的 ICER 为每 QALY 33,838 澳元（15,859 澳元）。ICER 估计值对 DBS 成本和选定的时间范围敏感。
根据现有非常有限的临床数据和特定假设，我们的研究表明 DBS 可能是治疗严重 TS 的一种具有成本效益的治疗方法。尽管数据的有限可用性带来了挑战，但我们还进行了敏感性分析，以测试分析中使用的假设对结果的稳健性。然而，我们仍然建议实施随机对照试验，该试验收集了全面的成本，并使用广泛接受的健康相关生活质量工具，以便更明确地说明 DBS 治疗 TS 的成本效益。
