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Longitudinal medication profile and cost savings in Parkinson’s disease patients after bilateral subthalamic nucleus deep brain stimulation

Abstract

Introduction

Deep brain stimulation of the subthalamic nucleus (STN DBS) has been shown to reduce antiparkinsonian medication in Parkinson’s disease. We aimed to investigate the changes in long-term medication profile with STN DBS.

Methods

Antiparkinsonian medication data for 56 patients were collected from as early as 3 years before STN DBS up to 10 years after. Cost spending on medication changes was analyzed. Mean levodopa equivalent daily dose (LEDD) was projected 10 years into the future based on preoperative data to create a comparator group wherein the patients did not undergo STN DBS. Use of neuroleptics and antidepressants was also recorded.

Results

LEDD requirement was significantly reduced by a mean of 31 ± 2% over 10 years after DBS, from 1049 ± 381 mg at pre-DBS baseline, to 713 ± 392 mg at 1 year post-DBS, and 712 ± 385 mg at 10 years post-DBS. This was associated with a mean reduction of 35 ± 3% in medicine cost. Modeled LEDD requirements for not having STN DBS were in the range of 1489 mg to 2721 mg at 10 years post-DBS (109–282% higher than the observed mean LEDD in DBS cohort). The proportion of patients increased from 5% before STN DBS to 14% at 10 year post-DBS for neuroleptics, and 11–23% for antidepressants.

Conclusion

STN DBS led to LEDD reduction and antiparkinsonian medication cost savings in our South-East Asian cohort. Medication reduction with STN DBS in our cohort over the 10-year period was comparable to those reported in Western populations.

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Funding

This research was supported by the Singapore Ministry of Health’s National Medical Research Council research grants (NMRC/CNIG/1173/2017 and TCMRG/NNI310301).

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AS and NK were responsible for the conception and design of the study. JN and AS were responsible for data collection. JN, AS, and NK were responsible for data analyses. JN, AS, ZX, and NK contributed to the interpretation of the data. JN and AS drafted the article, which was critically revised by all authors. All authors have approved the final version of the manuscript.

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Correspondence to Nicolas Kon Kam King.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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This retrospective review was carried out with waiver of consent by the SingHealth Centralized Institutional Review Board.

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Ng, J.H., See, A.A.Q., Xu, Z. et al. Longitudinal medication profile and cost savings in Parkinson’s disease patients after bilateral subthalamic nucleus deep brain stimulation. J Neurol 267, 2443–2454 (2020). https://doi.org/10.1007/s00415-020-09741-3

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Keywords

  • Antiparkinsonian medication
  • Subthalamic nucleus
  • Deep brain stimulation
  • Long term
  • Parkinson’s disease
  • Asian
  • Cost analysis