Journal Article

Early subthalamic nucleus deep brain stimulation in Parkinson’s disease reduces long-term medication costs

Turchan, Maxim, Phibbs, Fenna, Hedera, Peter, Charles, David, Cannard, Grace, Konrad, Peter, Meystedt, Jacqueline, Hacker, Mallory, Davis, Thomas

2021

Overview

Subthalamic nucleus (STN) deep brain stimulation (DBS) is recognized as a safe and effective treatment in mid- and advanced-staged Parkinson’s disease (PD) that decreases the need for PD medications and their associated costs. This study reports medication costs from the only clinical trial to evaluate DBS in patients with early-stage PD and projects costs through advanced-stage disease. The DBS in early-stage PD pilot was a prospective, single-blind clinical trial that randomized 30 patients with early-stage PD 1:1 to receive bilateral STN-DBS plus optimal drug therapy (ODT) or ODT alone. Subjects who completed the trial participated in an observational follow-up study and were evaluated annually for five years after randomization. PD medication data collected at each study visit were used to calculate and project medication costs (n = 28). Five-year cumulative medication cost reduction with early DBS+ODT was $28,246. Mean annual medication cost for early DBS+ODT subjects was 2.4 times lower than early ODT subjects (β = 2.4, 95%CI:1.5–3.7, p = 0.0004). Early DBS+ODT is projected to reduce cumulative medication costs by $104,958 over 15 years of disease duration. DBS in early-stage PD may provide long-term medication cost reduction compared to standard care. •Deep brain stimulation (DBS) in early Parkinson’s disease reduces PD medication use.•Early DBS provides long-term PD medication cost savings versus standard care.•Medication cost savings do not outweigh, but may partly offset, DBS-associated costs.

• Publisher: Elsevier B.V,Elsevier BV,Elsevier Limited
• Subject: Aged / Antiparkinson Agents / Antiparkinson Agents - economics / Antiparkinson Agents - therapeutic use / Clinical trials / Cost analysis / Cost control / Costs and Cost Analysis / Deep Brain Stimulation / Drug dosages / Drug prices / Drug therapy / Electrical stimuli / Female / Health Care Costs / Humans / Male / Medication cost / Middle Aged / Movement disorders / Neurodegenerative diseases / Neurology / Neurosurgery / Parkinson Disease / Parkinson Disease - drug therapy / Parkinson Disease - physiopathology / Parkinson Disease - therapy / Parkinson's disease / Patients / Pilot Projects / Quality of life / Single-Blind Method / Solitary tract nucleus / Statistical analysis / Subthalamic Nucleus / Subthalamic Nucleus - physiopathology / Treatment Outcome