Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Transl Psychiatry. 2024 Jun 7;14(1):243. doi: 10.1038/s41398-024-02951-7.
Treatment-resistant depression (TRD) affects approximately 2.8 million people in the U.S. with estimated annual healthcare costs of $43.8 billion. Deep brain stimulation (DBS) is currently an investigational intervention for TRD. We used a decision-analytic model to compare cost-effectiveness of DBS to treatment-as-usual (TAU) for TRD. Because this therapy is not FDA approved or in common use, our goal was to establish an effectiveness threshold that trials would need to demonstrate for this therapy to be cost-effective. Remission and complication rates were determined from review of relevant studies. We used published utility scores to reflect quality of life after treatment. Medicare reimbursement rates and health economics data were used to approximate costs. We performed Monte Carlo (MC) simulations and probabilistic sensitivity analyses to estimate incremental cost-effectiveness ratios (ICER; USD/quality-adjusted life year [QALY]) at a 5-year time horizon. Cost-effectiveness was defined using willingness-to-pay (WTP) thresholds of $100,000/QALY and $50,000/QALY for moderate and definitive cost-effectiveness, respectively. We included 274 patients across 16 studies from 2009-2021 who underwent DBS for TRD and had ≥12 months follow-up in our model inputs. From a healthcare sector perspective, DBS using non-rechargeable devices (DBS-pc) would require 55% and 85% remission, while DBS using rechargeable devices (DBS-rc) would require 11% and 19% remission for moderate and definitive cost-effectiveness, respectively. From a societal perspective, DBS-pc would require 35% and 46% remission, while DBS-rc would require 8% and 10% remission for moderate and definitive cost-effectiveness, respectively. DBS-pc will unlikely be cost-effective at any time horizon without transformative improvements in battery longevity. If remission rates ≥8-19% are achieved, DBS-rc will likely be more cost-effective than TAU for TRD, with further increasing cost-effectiveness beyond 5 years.
治疗抵抗性抑郁症（TRD）影响了美国约 280 万人，估计每年的医疗保健费用为 438 亿美元。深部脑刺激（DBS）目前是 TRD 的一种研究性干预措施。我们使用决策分析模型比较了 DBS 与 TRD 的常规治疗（TAU）的成本效益。由于这种治疗方法尚未获得 FDA 批准或广泛使用，我们的目标是确定一个疗效阈值，试验需要达到这个阈值才能证明这种治疗方法具有成本效益。缓解率和并发症发生率是通过对相关研究的回顾确定的。我们使用已发表的效用评分来反映治疗后的生活质量。我们使用医疗保险报销率和健康经济学数据来估算成本。我们进行了蒙特卡罗（MC）模拟和概率敏感性分析，以估计 5 年时间内的增量成本效益比（ICER；每质量调整生命年美元[QALY]）。使用愿意支付（WTP）阈值为 100,000 美元/QALY 和 50,000 美元/QALY 来定义成本效益，分别用于中度和确定性成本效益。我们的模型输入包括 2009 年至 2021 年期间进行 DBS 治疗 TRD 并随访至少 12 个月的 16 项研究中的 274 名患者。从医疗保健部门的角度来看，使用不可充电设备的 DBS（DBS-pc）需要 55%和 85%的缓解率，而使用可充电设备的 DBS（DBS-rc）需要 11%和 19%的缓解率才能达到中度和确定性成本效益。从社会角度来看，DBS-pc 需要 35%和 46%的缓解率，而 DBS-rc 需要 8%和 10%的缓解率才能达到中度和确定性成本效益。如果电池寿命没有得到重大改进，DBS-pc 在任何时间都不太可能具有成本效益。如果缓解率≥8-19%，那么 DBS-rc 治疗 TRD 可能比 TAU 更具成本效益，并且在 5 年之后的成本效益将进一步提高。
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