• Fann Jean Ching-Yuan JC Department of Health Industry Management, College of Healthcare Management, Kainan University, Taoyuan, Taiwan., Kai-Chieh Chang, Amy Ming-Fang Yen, Chen Sam Li-Sheng SL School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan., Chiu Sherry Yueh-Hsia SY Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Division of Hepatogastroenterolog, Hsiu-Hsi Chen, and Horng-Huei Liou.
• Department of Health Industry Management, College of Healthcare Management, Kainan University, Taoyuan, Taiwan.
• World Neurosurg. 2020 Jun 1; 138: e459-e468.

BackgroundDeep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective therapy for Parkinson disease (PD). However, cost-effectiveness analysis is required because most patients are older adults and decision makers must therefore consider whether the long-term effectiveness outweighs the initial cost.MethodsA Markov decision model was constructed on the basis of a societal perspective. The Hoehn and Yahr scale and Unified PD Rating Scale motor score were used in the polytomous logistic regression model. Markov Chain Monte Carlo simulation was used to initiate the probabilistic cost-effectiveness analysis.ResultsThe life-year gained (LYG) in the STN-DBS group and medication group was, respectively, 2.937 and 2.632 years at the 3-year follow-up and 7.417 and 5.971 years at the 10-year follow-up. The quality-adjusted life-year (QALY) gained in the STN-DBS and medication groups was, respectively, 1.739 and 1.220 at the 3-year follow-up and 4.189 and 2.88 at the 10-year follow-up. The incremental cost-effectiveness ratio of STN-DBS compared with medication was $147,065 per LYG and $123,436 per QALY gained at the 3-year follow-up and $36,833 and $69,033 at the 10-year follow-up, respectively. STN-DBS is an optimal strategy when the willingness to pay is $150,000 per LYG and over $90,000 per QALY gained in 3 years and when the willingness to pay is over $38,000 per LYG and over $41,000 per QALY gained in 10 years.ConclusionsThis study provided data comparing STN-DBS and medical treatment for PD with respect to LYG and QALY gained. STN-DBS was more cost-effective in terms of LYG and QALY gained according to the current gross domestic product of Taiwan.Copyright © 2020 Elsevier Inc. All rights reserved.

17 keywords...

hide…