Cost-Effectiveness Analysis of Deep Brain Stimulation in Patients with Parkinson's Disease in Japan

Yukiyoshi Kawamoto, Mitsuko Mouri, Takaomi Taira, Hiroshi Iseki, Ken Masamune

    Research output: Contribution to journalArticle

    10 Citations (Scopus)

    Abstract

    Objective: Deep brain stimulation (DBS) is an effective surgical option for treating Parkinson's disease (PD). DBS is invasive, with a high initial cost. In Japan, questions have been raised about its cost-effectiveness and the resulting improvements in outcome. The aim of this study was to evaluate the cost-effectiveness of DBS for PD in Japan, particularly whether early or late DBS is more cost-effective. Methods: We used a Markov cohort simulation to follow the clinical course of DBS for PD. We conducted a survey to capture QOL scores among healthy Japanese volunteers. Transition probabilities were estimated from randomized clinical trials. We determined direct medical costs from the perspective of the Japanese health care system. Outcomes were assessed as quality-adjusted life years. We conducted univariate and probabilistic sensitivity analyses. Results: DBS costs an additional 10.3 million Japanese yen (US$85,100; exchange rate on October 28, 2015 was 121 yen to $1) for a gain of 3.2 quality-adjusted life years. The incremental cost-effectiveness ratio was 3.1 million yen ($25,600). The incremental cost-effectiveness ratio was 8.5 million yen ($70,200) for early DBS, 3.1 million yen ($25,600) for intermediate DBS, and 3.3 million yen ($27,200) for late-stage DBS. Conclusions: Our model suggests that DBS is cost-effective in the Japanese health care system. DBS is more cost-effective if performed in the intermediate rather than early or late stages of PD.

    Original languageEnglish
    JournalWorld Neurosurgery
    DOIs
    Publication statusAccepted/In press - 2015 Aug 15

    Fingerprint

    Deep Brain Stimulation
    Cost-Benefit Analysis
    Parkinson Disease
    Japan
    Costs and Cost Analysis
    Quality-Adjusted Life Years
    Delivery of Health Care
    Healthy Volunteers
    Randomized Controlled Trials

    Keywords

    • Cost-effectiveness
    • Deep brain stimulation
    • Markov model
    • Parkinson's disease
    • QOL scores
    • Quality-adjusted life-year

    ASJC Scopus subject areas

    • Clinical Neurology
    • Surgery

    Cite this

    Cost-Effectiveness Analysis of Deep Brain Stimulation in Patients with Parkinson's Disease in Japan. / Kawamoto, Yukiyoshi; Mouri, Mitsuko; Taira, Takaomi; Iseki, Hiroshi; Masamune, Ken.

    In: World Neurosurgery, 15.08.2015.

    Research output: Contribution to journalArticle

    Kawamoto, Yukiyoshi ; Mouri, Mitsuko ; Taira, Takaomi ; Iseki, Hiroshi ; Masamune, Ken. / Cost-Effectiveness Analysis of Deep Brain Stimulation in Patients with Parkinson's Disease in Japan. In: World Neurosurgery. 2015.
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    abstract = "Objective: Deep brain stimulation (DBS) is an effective surgical option for treating Parkinson's disease (PD). DBS is invasive, with a high initial cost. In Japan, questions have been raised about its cost-effectiveness and the resulting improvements in outcome. The aim of this study was to evaluate the cost-effectiveness of DBS for PD in Japan, particularly whether early or late DBS is more cost-effective. Methods: We used a Markov cohort simulation to follow the clinical course of DBS for PD. We conducted a survey to capture QOL scores among healthy Japanese volunteers. Transition probabilities were estimated from randomized clinical trials. We determined direct medical costs from the perspective of the Japanese health care system. Outcomes were assessed as quality-adjusted life years. We conducted univariate and probabilistic sensitivity analyses. Results: DBS costs an additional 10.3 million Japanese yen (US$85,100; exchange rate on October 28, 2015 was 121 yen to $1) for a gain of 3.2 quality-adjusted life years. The incremental cost-effectiveness ratio was 3.1 million yen ($25,600). The incremental cost-effectiveness ratio was 8.5 million yen ($70,200) for early DBS, 3.1 million yen ($25,600) for intermediate DBS, and 3.3 million yen ($27,200) for late-stage DBS. Conclusions: Our model suggests that DBS is cost-effective in the Japanese health care system. DBS is more cost-effective if performed in the intermediate rather than early or late stages of PD.",
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