Cost-effectiveness analysis of MR-guided focused ultrasound thalamotomy for tremor-dominant Parkinson’s disease

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  • 1 Division of Neurosurgery, Sunnybrook Health Sciences Centre;
  • 2 Harquail Centre for Neuromodulation, Sunnybrook Research Institute;
  • 3 Division of Neurosurgery, Toronto Western Hospital, University Health Network;
  • 4 Krembil Research Institute, Toronto Western Hospital, University Health Network;
  • 5 Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University Health Network; and
  • 6 Tanz Centre for Research in Neurodegenerative Diseases, and
  • 7 Department of Medicine, Division of Neurology, University of Toronto, Ontario, Canada
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OBJECTIVE

The development of transcranial MR-guided focused ultrasound (MRgFUS) has revitalized the practice of lesioning procedures in functional neurosurgery. Previous health economic analysis found MRgFUS thalamotomy to be a cost-effective treatment for patients with essential tremor, supporting its reimbursement. With the publication of level I evidence in support of MRgFUS thalamotomy for patients with tremor-dominant Parkinson’s disease (TDPD), the authors performed a health economic comparison between MRgFUS, deep brain stimulation (DBS), and medical therapy.

METHODS

The authors used a decision tree model with rollback analysis and one-factor sensitivity analysis. Literature searches of MRgFUS thalamotomy and unilateral DBS of the ventrointermediate nucleus of the thalamus for TDPD were performed to determine the utility and probabilities for the model. Costs in Canadian dollars (CAD) were derived from the Schedule of Benefits and Fees in Ontario, Canada, and expert opinion on usage.

RESULTS

MRgFUS was associated with an expected cost of $14,831 CAD. Adding MRgFUS to continued medical therapy resulted in an incremental cost-effectiveness ratio of $30,078 per quality-adjusted life year (QALY), which remained cost-effective under various scenarios in the sensitivity analysis. Comparing DBS to MRgFUS, while DBS did not achieve the willingness-to-pay threshold ($56,503 per QALY) in the base case scenario, it did so under several scenarios in the sensitivity analysis.

CONCLUSIONS

MRgFUS thalamotomy is a cost-effective treatment for patients with TDPD, particularly over continued medical therapy. While MRgFUS remains competitive with DBS, the cost-effectiveness advantage is less substantial. These results will help inform the integration of this technology in the healthcare system.

ABBREVIATIONS DBS = deep brain stimulation; ICER = incremental cost-effectiveness ratio; MRgFUS = MR-guided focused ultrasound; PD = Parkinson’s disease; QALY = quality-adjusted life year; TDPD = tremor-dominant PD; VIM = ventrointermediate nucleus.

Supplementary Materials

    • Supplementary Materials (PDF 641 KB)

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Contributor Notes

Correspondence Nir Lipsman: Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. nir.lipsman@utoronto.ca.

INCLUDE WHEN CITING Published online August 7, 2020; DOI: 10.3171/2020.5.JNS20692.

Disclosures Dr. S. K. Kalia reports being a consultant for Medtronic. Dr. L. V. Kalia reports that her spouse is a consultant for Medtronic; she is funded by a Canadian Institutes of Health Research Clinician Scientist Award. Dr. Lipsman has received honoraria for serving on an expert steering committee for the Focused Ultrasound Foundation, as well as research support from the Focused Ultrasound Foundation and InSightec. Dr. Meng has been supported by a conference travel award from the Focused Ultrasound Foundation. Dr. Meng’s research activities are supported by Physicians’ Services Incorporated.

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