Can responsive deep brain stimulation be a cost‐effective treatment for severe obesity?

Abstract

The global obesity epidemic has an undeniably high economic burden, with its associated annual medical spending in the US alone totaling $150 billion in 2010 (1). The financial cost per patient with obesity is similarly high in other nations, including in low-and middle-income countries (2). At the turn of the 21st century, obesity accounted for up to 3% of a country's total health expenditures (3). In the years following, both the global prevalence of obesity and disease burden related to high BMI have steadily increased within every sociodemographic quintile (4). Most recently, the societal safety measures imposed during the COVID-19 pandemic will likely have long-term negative effects on the obesity epidemic (5).Notably, the relationship between BMI and health care costs is nonlinear, i.e., health care costs rise exponentially for the few individuals with the most severe obesity (6). Indeed, the 10% of the population of individuals with overweight/obesity with the highest BMI account for more than 60% of the global disease burden related to obesity (7). Therefore, it becomes critical to identify, examine, and provide cost-effective treatments for individuals with severe obesity. Bariatric surgery is an established treatment for severe obesity, shown to be cost-effective in the US (8), Europe (9), Asia (10), South America (11), and Australia (12). However, in patients with severe

Responsive nucleus accumbens deep brain stimulation restores eating control in severe obesity

“…To account for detection and stimulation during sleep, we limited rDBS delivery to awake hours (7am-10pm). Finally, the upfront cost of implantable devices is high; thus long-term follow-up of LOC eating as well as BMI beyond the study period will be necessary to assess societal cost-effectiveness of this intervention based on our decision analyses 23 .…”

Novel Insights into the Physiology of Nutrient Sensing and Gut-Brain Communication in Surgical and Experimental Obesity Therapy

“…Very recently, a DBS clinical pilot was conducted on two patients, where the electrophysiological signatures of food craving were used to activate implanted DBS to enhance inhibitory control [129]. After six months, the BMI of both subjects decreased by 2-3 kg/ m 2 , which is clearly inferior to what can be achieved with BS [130].…”