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Economic evaluation of deep-brain stimulation for Tourette’s syndrome: an initial exploration

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Abstract

Background

Deep-brain stimulation (DBS) can be effective in controlling medically intractable symptoms of Tourette’s syndrome (TS). There is no evidence to date, though, of the potential cost-effectiveness of DBS for this indication.

Objective

To provide the first estimates of the likely cost-effectiveness of DBS in the treatment of severe TS.

Methods

We conducted a cost-utility analysis using clinical data from 17 Australian patients receiving DBS. Direct medical costs for DBS using non-rechargeable and rechargeable batteries and for the alternative best medical treatment (BMT), and health utilities for BMT were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated using a Markov models with a 10-year time horizon and 5% discount rate.

Results

DBS increased quality-adjusted life year (QALY) gained from 2.76 to 4.60 over a 10-year time horizon. The ICER for DBS with non-rechargeable (rechargeable) batteries, compared to BMT, was A$33,838 (A$15,859) per QALY. The ICER estimates are sensitive to DBS costs and selected time horizon.

Conclusions

Our study indicates that DBS may be a cost-effective treatment for severe TS, based on the very limited clinical data available and under particular assumptions. While the limited availability of data presents a challenge, we also conduct sensitivity analyses to test the robustness of the results to the assumptions used in the analysis. We nevertheless recommend the implementation of randomised controlled trials that collect a comprehensive range of costs and the use of a widely accepted health-related quality of life instrument to enable more definitive statements about the cost-effectiveness of DBS for TS.

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Funding

At the time of conducting the research, TD received a Ph.D. scholarship from and DR, JL, TC, and PS were employed by the Asia–Pacific Centre for Neuromodulation (APCN). The APCN was in part funded by unrestricted research and education funding from Medtronic Inc. and St Andrew’s War Memorial Hospital. The funding bodies played no part in the design or conduct of the research or its reporting.

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Authors and Affiliations

  1. Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia

    Tho T. H. Dang, Terry Coyne, Peter Silburn & Luke B. Connelly

  2. Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia

    Tho T. H. Dang, David Rowell & Luke B. Connelly

  3. School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia

    Jacki Liddle

  4. Dipartimento di Sociologia e Diritto dell’Economia, The University of Bologna, Bologna, Italy

    Luke B. Connelly

Authors
  1. Tho T. H. Dang
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  2. David Rowell
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  3. Jacki Liddle
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  4. Terry Coyne
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  5. Peter Silburn
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  6. Luke B. Connelly
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Contributions

1. Research project: A. Conception, B. Organization, C. Execution; 2. Statistical Analysis: A. Design, B. Execution, C. Review and Critique; 3. Manuscript: A. Writing of the first draft, B. Review and Critique. TD: 1A, 1B, 2A, 2B, 3A, DR: 1A, 2A, 2C, 3B, JL: 3B, TC: 3B, PS: 3B, LC: 2C, 3B.

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Correspondence to Tho T. H. Dang.

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LC reports no conflicts of interest.

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The manuscript does not contain clinical studies or patient data.

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Dang, T.T.H., Rowell, D., Liddle, J. et al. Economic evaluation of deep-brain stimulation for Tourette’s syndrome: an initial exploration. J Neurol 266, 2997–3008 (2019). https://doi.org/10.1007/s00415-019-09521-8

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  • DOI: https://doi.org/10.1007/s00415-019-09521-8

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