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Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis

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Abstract

Alzheimer disease (AD) is characterized by impairments in memory function. Standard AD treatment provides marginal improvements in this domain. Recent reports, however, suggested that deep brain stimulation (DBS) may result in improved memory. Given significant equipment costs and health expenses required for DBS surgery, we determine clinical and economic thresholds required for it to be as effective as standard AD treatment. Literature review yielded annual AD progression probabilities, health-related quality of life (QoL), and costs by AD stage. Our 5-year decision analysis model compared cumulative QoL in quality-adjusted life years (QALYs) and costs of standard therapy to theoretical DBS treatment of various success rates, using known complication rates and QoL data. The base case was a patient with mild-stage AD. DBS success was defined as regression to and maintenance of minimal stage AD, which was defined as midway between mild and no dementia, for the first year, and continuation of the natural course of AD for the remaining 4 years. Compared to standard treatment alone, DBS for mild-stage AD requires a success rate of 3 % to overcome effects of possible surgical complications on QoL. If DBS can be delivered with success rates above 20 % ($200 K/QALY) or 74 % ($50 K/QALY) for mild AD, it can be considered cost-effective. Above a success rate of 80 %, DBS treatment is both clinically more effective and more cost-effective than standard treatment. Our findings demonstrate that clinical and economic thresholds required for DBS to be cost-effective for AD are relatively low.

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Acknowledgments

We would like to thank Dr Murray Grossman for his invaluable contributions to the design of the virtual clinical trial conducted.

Conflicts of interest

David Wolk has declared his current participation in a clinical trial sponsored by Functional Neuromodulation, Ltd in the study of deep brain stimulation in AD. None of the other authors have any conflict of interests to declare.

Ethical standard

No patients were engaged to obtain data for this study. As a result, no informed consent was needed or obtained by the Ethics Committee of the University of Pennsylvania Health System.

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Authors and Affiliations

  1. Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421 (6th floor), Philadelphia, PA, 19104, USA

    Keyvan Mirsaeedi-Farahani

  2. Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA

    C. H. Halpern

  3. Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA

    G. H. Baltuch & S. C. Stein

  4. Department of Neurology, University of Pennsylvania, Philadelphia, USA

    D. A. Wolk

Authors
  1. Keyvan Mirsaeedi-Farahani
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  2. C. H. Halpern
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  3. G. H. Baltuch
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  4. D. A. Wolk
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  5. S. C. Stein
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Correspondence to Keyvan Mirsaeedi-Farahani.

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Mirsaeedi-Farahani, K., Halpern, C.H., Baltuch, G.H. et al. Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis. J Neurol 262, 1191–1197 (2015). https://doi.org/10.1007/s00415-015-7688-5

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  • DOI: https://doi.org/10.1007/s00415-015-7688-5

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