Author(s): Eggington S.; Autiero S.W.; Stromberg K.; Weaver T.; Eldridge P.R.
Source: Stereotactic and Functional Neurosurgery; 2017; vol. 95 ; p. 227
Publication Date: 2017
Publication Type(s): Conference Abstract
Abstract:Objectives: Deep brain stimulation (DBS) is a recommended option for the treatment of movement disorders in well-selected patients. Both rechargeable and non-rechargeable devices are available; one of the advantages of a rechargeable DBS device may lie in the avoidance of costs for battery replacements and associated risks and hospitalisations. The objective of this study was to evaluate the economic impact of using a rechargeable DBS device over a non-rechargeable device in patients treated for either Parkinson’s Disease (PD) or Dystonia. Methods: An economic model (Markov Model) was built to follow a group of dystonia and PD DBS patients over time comparing two scenarios, one assuming a rechargeable and one assuming a non-rechargeable device, for first implant and replacements. The model captures patients’ replacement surgeries, hospitalisations, adverse events and deaths. Data for the model were sourced from the Medtronic product surveillance registry (PSR; patient characteristics, adverse events and consequences associated with implant and replacement surgeries) and non-rechargeable device longevity data from Medtronic performance registry based modelling analyses. For the rechargeable device longevity, current longevity (9 years) and a hypothetical longevity scenario (15 years) were tested. Clinical expert advice was used to inform model assumptions. Costs were estimated from a UK health care perspective. Sensitivity analyses were undertaken to test for parameter uncertainty, including time horizon. Results: Results of the base case analysis (16 year time horizon) show:For PD,an average of 3.68 battery replacements in the non-rechargeable vs 0.62 in the rechargeable group; for Dystonia, 5.08 and 0.74 replacements in the non-rechargeable vs the rechargeable group(15-year hypothetical device longevity). Over 16 years,the model suggests cost savings of 15,564 (PD) and 27,954 (Dystonia) using the 9 year device longevity, and 20,418 and 32,060, respectively, for a 15-year hypothetical device longevity. Sensitivity analyses showed that over a patient’s life time, cost savings were 28,450(PD) and 65,413(dystonia)(15-year hypothetical device longevity). Conclusion: The use of a rechargeable DBS device in this model is cost saving in the long-term compared to a nonrechargeable device. Prolonging rechargeable device life to 15 years is predicted to reduce DBS treatment costs and would thus improve DBS therapy cost-effectiveness, for both PD and dystonia. This analysis was funded by Medtronic. Simon Eggington, Katherine Stromberg, Silke Walleser Autiero and Todd Weaver are employees of Medtronic. Professor Paul Eldridge received compensation for his work providing clinical advice and review on this project.