Sasidharan Akhil, Bagepally Bhavani Shankara, Kumar S Sajith
ICMR-National Institute of Epidemiology, Health Technology Assessment Resource Centre, ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India.
Appl Health Econ Health Policy. 2024 Mar;22(2):181-192. doi: 10.1007/s40258-023-00848-y. Epub 2023 Nov 28.
Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD) in patients with advanced motor symptoms with an inadequate response to pharmacotherapies. Despite its effectiveness, the cost effectiveness of DBS remains a subject of debate. This systematic review aims to update and synthesize evidence on the cost effectiveness of DBS for PD.
To identify full economic evaluations that compared the cost effectiveness of DBS with other best medical treatments, a comprehensive search was conducted of the PubMed, Embase, Scopus, and Tufts Cost-Effective Analysis registry databases. The selected papers were systematically reviewed, and the results were summarized. For the quality appraisal, we used the modified economic evaluations bias checklist. The review protocol was a priori registered with PROSPERO, CRD42022345508.
Sixteen identified cost-utility analyses that reported 19 comparisons on the use of DBS for PD were systematically reviewed. The studies were primarily conducted in high-income countries and employed Markov models. The costs considered were direct costs: surgical expenses, calibration, pulse generator replacement, and annual drug expenses. The majority of studies used country-specific thresholds. Fourteen comparisons from 12 studies reported on the cost effectiveness of DBS compared to best medical treatments. Eleven comparisons reported DBS as cost effective based on incremental cost-utility ratio results.
The cost effectiveness of DBS for PD varies by time horizon, costs considered, threshold utilized, and stage of PD progression. Standardizing approaches and comparing DBS with other treatments are needed for future research on effective PD management.
对于运动症状严重且药物治疗反应不佳的帕金森病（PD）患者，深部脑刺激（DBS）是一种已确立的治疗方法。尽管其疗效显著，但DBS的成本效益仍是一个有争议的话题。本系统评价旨在更新和综合关于DBS治疗PD成本效益的证据。
为了确定将DBS与其他最佳药物治疗的成本效益进行比较的全面经济评估，我们对PubMed、Embase、Scopus和塔夫茨成本效益分析注册数据库进行了全面检索。对所选论文进行系统评价，并总结结果。对于质量评估，我们使用了修改后的经济评估偏倚清单。该评价方案已在PROSPERO上预先注册，注册号为CRD42022345508。
系统评价了16项已确定的成本效用分析，这些分析报告了19项关于使用DBS治疗PD的比较。这些研究主要在高收入国家进行，并采用了马尔可夫模型。所考虑的成本为直接成本：手术费用、校准费用、脉冲发生器更换费用和年度药物费用。大多数研究使用了特定国家的阈值。12项研究中的14项比较报告了DBS与最佳药物治疗相比的成本效益。11项比较根据增量成本效用比结果报告DBS具有成本效益。
DBS治疗PD的成本效益因时间范围、所考虑的成本、所采用的阈值以及PD进展阶段而异。未来关于有效PD管理的研究需要标准化方法并将DBS与其他治疗进行比较。
