Radwan Hesham, Fayed Zeiad Yousry, Elserry Tarek, Alkarras Mazen T, Shalash Ali, Shehata Zahraa Hassan, Noureldin Nour Walid, Metry Andrew, Basha Ahmed Kamel
Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Appl Health Econ Health Policy. 2025 Aug 25. doi: 10.1007/s40258-025-00999-0.
Deep brain stimulation (DBS) has proven efficacy in advanced Parkinson's disease (PD) and is the current standard of care for these patients. However, its cost-effectiveness in low- and middle-income settings has not been assessed before.
This study aims to assess the cost-effectiveness of DBS compared with best medical therapy (BMT) in advanced PD from a societal perspective in Egypt.
We developed a Markov model with a 15-year time horizon and annual cycles to compare DBS with BMT. The cohort was aged 55-years-old at model entry and transitioned between three states: DBS, BMT, or death. Effectiveness was measured by improvement in the Unified Parkinson's Disease Rating Scale (UPDRS) and reduction in drug doses. The main outcome was quality-adjusted life years (QALYs) mapped from the UPDRS scores. The model included medical, informal care, and indirect costs. Both costs and utilities were discounted at an annual rate of 3.5%.
DBS had yielded an increase of 1.4 QALYs per patient at an additional cost of 1,159,150 Egyptian pounds (EGP)/patient ($25,566). This results in an incremental cost-effectiveness ratio (ICER) of 830,726 EGP/QALY ($18,322/QALY). Patients with DBS have lower costs for medications, hospitalizations, informal care, and productivity loss. The main cost driver in the DBS arm is the device and implantation procedure costs, which accounted for 70% of total costs. The model was most sensitive to informal care costs.
DBS markedly improves the quality of life for advanced patients with PD and reduces informal care and indirect costs. However, at its current price, the ICER exceeds the Egyptian cost-effectiveness threshold.
脑深部电刺激术（DBS）已被证明对晚期帕金森病（PD）有效，是这些患者当前的标准治疗方法。然而，此前尚未评估其在低收入和中等收入环境中的成本效益。
本研究旨在从埃及社会角度评估DBS与最佳药物治疗（BMT）相比在晚期PD中的成本效益。
我们开发了一个具有15年时间范围和年度周期的马尔可夫模型，以比较DBS和BMT。队列在模型进入时年龄为55岁，在三种状态之间转换：DBS、BMT或死亡。有效性通过统一帕金森病评定量表（UPDRS）的改善和药物剂量的减少来衡量。主要结果是根据UPDRS评分得出的质量调整生命年（QALYs）。该模型包括医疗、非正式护理和间接成本。成本和效用均按每年3.5%的比率进行贴现。
DBS使每位患者的QALYs增加了1.4个，每位患者的额外成本为1,159,150埃及镑（EGP）/患者（25,566美元）。这导致增量成本效益比（ICER）为830,726 EGP/QALY（18,322美元/QALY）。接受DBS治疗的患者在药物、住院、非正式护理和生产力损失方面的成本较低。DBS组的主要成本驱动因素是设备和植入手术成本，占总成本的70%。该模型对非正式护理成本最为敏感。
DBS显著改善了晚期PD患者的生活质量，降低了非正式护理和间接成本。然而，按其当前价格，ICER超过了埃及的成本效益阈值。
