Cost-effectiveness analysis of MR-guided focused ultrasound thalamotomy for tremor-dominant Parkinson's disease.
Cost-effectiveness analysis of MR-guided focused ultrasound thalamotomy for tremor-dominant Parkinson's disease.
复制标题
MR 引导聚焦超声丘脑切除术治疗震颤为主的帕金森病的成本效益分析。
作者：
Y. Meng;Christopher B. Pople;Suneil K. Kalia;L. Kalia;B. Davidson;Luca Bigioni;D. Li;S. Suppiah;Karim Mithani;N. Scantlebury;M. Schwartz;C. Hamani;N. Lipsman
目的
经颅磁共振引导聚焦超声（MRgFUS）的发展使功能性神经外科中的病变手术实践重新焕发了活力。先前的卫生经济学分析发现，MRgFUS丘脑切开术是原发性震颤患者的一种具有成本效益的治疗方法，支持其报销。随着I级证据支持震颤显性帕金森病（TDPD）患者的MRgFUS丘脑切开术的发表，作者对MRgFUS、脑深部电刺激（DBS）和药物治疗进行了健康经济学比较。
方法
作者使用了决策树模型与回滚分析和单因素敏感性分析。对MRgFUS丘脑切开术和丘脑腹中间核单侧DBS治疗TDPD的文献进行了检索，以确定该模型的实用性和概率。以加元计算的费用来自加拿大安大略的福利和费用表以及专家对使用情况的意见。
结果
MRgFUS的预期成本为14，831加元。将MRgFUS添加到持续药物治疗中导致每质量调整生命年（QALY）增加30，078美元的成本效益比，在敏感性分析的各种情况下仍然具有成本效益。将DBS与MRgFUS进行比较，虽然DBS在基本情况下没有达到支付意愿阈值（每QALY 56，503美元），但在敏感性分析的几种情况下都达到了。
结论
MRgFUS丘脑切开术对于TDPD患者是一种具有成本效益的治疗方法，特别是在持续药物治疗中。虽然MRgFUS与DBS相比仍然具有竞争力，但成本效益优势不太明显。这些结果将有助于将这项技术整合到医疗保健系统中。
OBJECTIVE
The development of transcranial MR-guided focused ultrasound (MRgFUS) has revitalized the practice of lesioning procedures in functional neurosurgery. Previous health economic analysis found MRgFUS thalamotomy to be a cost-effective treatment for patients with essential tremor, supporting its reimbursement. With the publication of level I evidence in support of MRgFUS thalamotomy for patients with tremor-dominant Parkinson's disease (TDPD), the authors performed a health economic comparison between MRgFUS, deep brain stimulation (DBS), and medical therapy.
METHODS
The authors used a decision tree model with rollback analysis and one-factor sensitivity analysis. Literature searches of MRgFUS thalamotomy and unilateral DBS of the ventrointermediate nucleus of the thalamus for TDPD were performed to determine the utility and probabilities for the model. Costs in Canadian dollars (CAD) were derived from the Schedule of Benefits and Fees in Ontario, Canada, and expert opinion on usage.
RESULTS
MRgFUS was associated with an expected cost of $14,831 CAD. Adding MRgFUS to continued medical therapy resulted in an incremental cost-effectiveness ratio of $30,078 per quality-adjusted life year (QALY), which remained cost-effective under various scenarios in the sensitivity analysis. Comparing DBS to MRgFUS, while DBS did not achieve the willingness-to-pay threshold ($56,503 per QALY) in the base case scenario, it did so under several scenarios in the sensitivity analysis.
CONCLUSIONS
MRgFUS thalamotomy is a cost-effective treatment for patients with TDPD, particularly over continued medical therapy. While MRgFUS remains competitive with DBS, the cost-effectiveness advantage is less substantial. These results will help inform the integration of this technology in the healthcare system.
影响因子：
4.2
作者：
Li X;Du L;Sahlem GL;Badran BW;Henderson S;George MS
通讯作者：
George MS