Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor
In: Movement Disorders, Jg. 32 (2017-04-03), S. 1165-1173
Online
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Zugriff:
Background Essential tremor remains a very common yet medically refractory condition. A recent phase 3 study demonstrated that magnetic resonance-guided focused ultrasound thalamotomy significantly improved upper limb tremor. The objectives of this study were to assess this novel therapy's cost-effectiveness compared with existing procedural options. Methods Literature searches of magnetic resonance-guided focused ultrasound thalamotomy, DBS, and stereotactic radiosurgery for essential tremor were performed. Pre- and postoperative tremor-related disability scores were collected from 32 studies involving 83 magnetic resonance-guided focused ultrasound thalamotomies, 615 DBSs, and 260 stereotactic radiosurgery cases. Utility, defined as quality of life and derived from percent change in functional disability, was calculated; Medicare reimbursement was employed as a proxy for societal cost. Medicare reimbursement rates are not established for magnetic resonance-guided focused ultrasound thalamotomy for essential tremor; therefore, reimbursements were estimated to be approximately equivalent to stereotactic radiosurgery to assess a cost threshold. A decision analysis model was constructed to examine the most cost-effective option for essential tremor, implementing meta-analytic techniques. Results Magnetic resonance-guided focused ultrasound thalamotomy resulted in significantly higher utility scores compared with DBS (P < 0.001) or stereotactic radiosurgery (P < 0.001). Projected costs of magnetic resonance-guided focused ultrasound thalamotomy were significantly less than DBS (P < 0.001), but not significantly different from radiosurgery. Conclusions Magnetic resonance-guided focused ultrasound thalamotomy is cost-effective for tremor compared with DBS and stereotactic radiosurgery and more effective than both. Even if longer follow-up finds changes in effectiveness or costs, focused ultrasound thalamotomy will likely remain competitive with both alternatives. © 2017 International Parkinson and Movement Disorder Society
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Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor
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Autor/in / Beteiligte Person: | Halpern, Casey H. ; Hornbeck, Traci S. ; Parker, Jonathon J. ; Stein, Sherman C. ; Santini, Veronica ; Vinod K Ravikumar ; Wintermark, Max ; Ghanouni, Pejman ; Kim Butts Pauly |
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Zeitschrift: | Movement Disorders, Jg. 32 (2017-04-03), S. 1165-1173 |
Veröffentlichung: | Wiley, 2017 |
Medientyp: | unknown |
ISSN: | 0885-3185 (print) |
DOI: | 10.1002/mds.26997 |
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