Journal of Neurology

, Volume 252, Issue 2, pp 218–223 | Cite as

Deep brain stimulation in late stage Parkinson’s disease: a retrospective cost analysis in Germany

  • Wassilios Meissner
  • Doreen Schreiter
  • Jens Volkmann
  • Thomas Trottenberg
  • Gerd-Helge Schneider
  • Volker Sturm
  • Guenther Deuschl
  • Andreas Kupsch


During the last few years, deep brain stimulation (DBS) of the subthalamic nucleus (STN) has emerged as a promising therapy, alleviating major motor symptoms of Parkinson’s disease (PD). However, in times of growing budgetary limitations, medical decisions are no longer merely based on clinical efficacy, but also on cost-effectiveness. Here we assess treatment costs (i. e. costs for conservative pharmacological treatment and all in-patient admissions) of 46 PD patients for one year before and two years after STN-DBS. The present data show that total treatment costs were increased by 32 % for the first year and decreased by 54 % for the second year of STN-DBS in comparison with preoperative values while the Unified Parkinon’s Disease Rating Scale (UPDRS III) was significantly improved. The increase for the first year after surgery was mainly due to the implantation of the STN electrodes and the stimulation device. Taken together, STNDBS pays off from the second year of stimulation while motor symptoms are significantly improved. The present study provides first data of an important number of patients on clinical effectiveness and expenses in relation to STNDBS.

Key words

Parkinson’s disease deep brain stimulation subthalamic nucleus cost-effectiveness 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Benabid AL, Pollak P (2000) Cost assessment of functional neurosurgery for abnormal movement by stimulation of the basal nuclei, particularly the subthalamic nucleus. Rev Neurol (Paris) 156(Suppl 2)Pt 2:270–273Google Scholar
  2. 2.
    Blumenschein K, Johannesson M (1996) Incorporating quality of life changes into economic evaluations of health care: an overview. Health Policy 36:155–166Google Scholar
  3. 3.
    Bundesverband der pharmazeutischen Industrie, Rote Liste, Rote Liste Verlag, Weinheim, 2002Google Scholar
  4. 4.
    Burchiel KJ, Anderson VC, Favre J, Hammerstad JP (1999) Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson’s disease: results of a randomized, blinded pilot study. Neurosurgery 45:1375–1382PubMedGoogle Scholar
  5. 5.
    Dodel RC, Berger K, Oertel WH (2001) Health-related quality of life and healthcare utilisation in patients with Parkinson’s disease: impact of motor fluctuations and dyskinesias. Pharmacoeconomics 19:1013–1038Google Scholar
  6. 6.
    Ehringer H, Hornykiewicz O (1960) Verteilung von Noradrenalin und Dopamin (3-Hydroxytyramin) im Gehirn des Menschen und ihr Verhalten bei Erkrankungen des extrapyramidalen Systems. Klin Wochenschr 38:1236–1239Google Scholar
  7. 7.
    Fahn S, Elton RL (1987) Committee MotUD: Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD (eds) Recent developments in Parkinson’s disease. Florham Park, Macmillan Health Care, pp 153–164Google Scholar
  8. 8.
    Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, Lebas JF, Benabid AL, Pollak P (2003) Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 349:1925–1934CrossRefPubMedGoogle Scholar
  9. 9.
    Krack P, Limousin P, Benabid AL, Pollak P (1997) Chronic stimulation of subthalamic nucleus improves levodopa-induced dyskinesias in Parkinson’s disease. Lancet 350:1676Google Scholar
  10. 10.
    Kumar R, Lozano AM, Kim YJ, Hutchison WD, Sime E, Halket E, Lang AE (1998) Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease. Neurology 51:850–855PubMedGoogle Scholar
  11. 11.
    Lang AE, Widner H (2002) Deep brain stimulation for Parkinson’s disease: patient selection and evaluation. Mov Disord 17(Suppl 3):S94–S101Google Scholar
  12. 12.
    Laupacis A, Feeny D, Detsky AS, Tugwell PX (1992) How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J 146:473–481Google Scholar
  13. 13.
    Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D, Benabid AL (1998) Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 339:1105–1111CrossRefPubMedGoogle Scholar
  14. 14.
    Mandelblatt JS, Fryback DG, Weinstein MC, Russell LB, Gold MR (1997) Assessing the effectiveness of health interventions for cost-effectiveness analysis. Panel on Cost-Effectiveness in Health and Medicine. J Gen Intern Med 12:551–558Google Scholar
  15. 15.
    Marsden CD, Parkes JD, Quinn N (1982) Fluctuations of disability in Parkinson’s disease—clinical aspects. In: Marsden CD, Fahn S (eds) Neurology 2: Movement Disorders. London, Butterworth Scientific, pp 96–122Google Scholar
  16. 16.
    Meissner W, Hill M, Tison F,Gross CE, Bezard E (2004) Neuroprotective strategies for Parkinson’s disease: conceptual limits of animal models and clinical trials. Trends Pharmacol Sci 25:249–253Google Scholar
  17. 17.
    Moro E, Scerrati M, Romito LM, Roselli R, Tonali P, Albanese A (1999) Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson’s disease. Neurology 53:85–90PubMedGoogle Scholar
  18. 18.
    Rodriguez-Oroz MC, Gorospe A, Guridi J, Ramos E, Linazasoro G, Rodriguez-Palmero M, Obeso JA (2000) Bilateral deep brain stimulation of the subthalamic nucleus in Parkinson’s disease. Neurology 55:S45–S51Google Scholar
  19. 19.
    Shils JL, Miravite J, Tagliati M, Alterman RL (2002) Economic impact of the reduction in medication requirements after STN deep brain stimulation in Parkinson’s disease. Mov Disord 17(Suppl 5):S194Google Scholar
  20. 20.
    Spottke EA, Volkmann J, Lorenz D, Krack P, Smala AM, Sturm V, Gerstner A, Berger K, Hellwig D, Deuschl G, Freund HJ, Oertel WH, Dodel RC (2002) Evaluation of healthcare utilization and health status of patients with Parkinson’s disease treated with deep brain stimulation of the subthalamic nucleus. J Neurol 249:759–766Google Scholar
  21. 21.
    Tomaszewski KJ, Holloway RG (2001) Deep brain stimulation in the treatment of Parkinson’s disease: a costeffectiveness analysis. Neurology 57:663–671Google Scholar
  22. 22.
    Volkmann J, Allert N, Voges J, Weiss PH, Freund HJ, Sturm V (2001) Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology 56:548–551PubMedGoogle Scholar

Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • Wassilios Meissner
    • 5
  • Doreen Schreiter
    • 5
  • Jens Volkmann
    • 1
    • 2
  • Thomas Trottenberg
    • 5
  • Gerd-Helge Schneider
    • 3
  • Volker Sturm
    • 4
  • Guenther Deuschl
    • 1
  • Andreas Kupsch
    • 5
  1. 1.Department of NeurologyChristian Albrechts UniversityKielGermany
  2. 2.Department of NeurologyHeinrich Heine UniversityDuesseldorfGermany
  3. 3.Department of NeurosurgeryCharité, Campus Virchow-Klinikum, Humboldt UniversityBerlinGermany
  4. 4.Department of Stereotactic and Functional NeurosurgeryUniversity of CologneCologneGermany
  5. 5.Department of NeurologyCharité, Campus Virchow-Klinikum, Humboldt UniversityBerlinGermany

Personalised recommendations