Cost-Effectiveness of Device-Aided Therapies in Parkinson’s Disease: A Structured Review

Abstract

Background: Despite optimal dopaminergic treatment most patients in moderate to advanced stages of Parkinson’s disease (PD) experience progressively increasing disabilities, necessitating a shift from oral medication to device-aided therapies, including deep brain stimulation (DBS), intrajejunal levodopa-carbidopa infusion (IJLI), and continuous subcutaneous apomorphine infusion (CSAI). However, these therapies are costly, limiting their implementation. Objectives: To perform a systematic review on cost-effectiveness analyses for device-aided therapies in PD. Methods: References were identified by performing a systematic search in the PubMed and Web of Science databases in accordance with the PRISMA statement. In the absence of universal cost-effectiveness definitions, the gross domestic product per capita (GDP) in the country where a study was performed was used as a cut-off for cost-effectiveness based on cost per quality adjusted life year (QALY) gained. Results: In total 30 studies were retrieved. All device-aided therapies improved quality of life compared to best medical treatment, with improvements in QALYs between 0.88 and 1.26 in the studies with long temporal horizons. For DBS, nearly all studies showed that cost per QALY was below the GDP threshold. For infusion therapies only three studies showed a cost per QALY below this threshold, with several studies with long temporal horizons showing costs below or near the GDP threshold. Conclusion: Of the device-aided therapies, DBS can be considered cost-effective, but the majority of infusion therapy studies showed that these were less cost-effective. However, long-term use of the infusion therapies appears to improve their cost-effectiveness and in addition, several strategies are underway to reduce these high costs.

Combined and Sequential Treatment with Deep Brain Stimulation and Continuous Intrajejunal Levodopa Infusion for Parkinson’s Disease

“…A study estimated a mean cumulative 5-year cost of EUR 89,477 for DBS and EUR 234,643 for CLI treatment alone [28]. Of the three device-aided therapies in PD, DBS was considered a cost-effective therapy; this was not so clear for CLI and CAI [29]. Although our study did not cover costs, these should be taken into account when introduction of a second advanced treatment is considered.…”

European Academy of Neurology/Movement Disorder Society ‐ European Section guideline on the treatment of Parkinson's disease: I. Invasive therapies

“…However, the EAN is working on including this in the future. A number of careful studies are available that compare the costs for the different treatments for specific countries [35, 96–101].…”

“…However, the EAN is working on including this in the future. A number of careful studies are available that compare the costs for the different treatments for specific countries[35,[96][97][98][99][100][101].Several invasive interventions for PD have undergone a rapid development, with DBS of the STN and GPi being established treatments for the improvement of motor symptoms and healthrelated QoL[20]. Further questions on the use of DBS for psychosocial impact and nonmotor symptoms in PD as well as the possible usefulness for axial abnormalities still need to be answered.…”

Covid-19 and Parkinson's disease: Nursing care, vaccination and impact on advanced therapies

“…These treatments, including continuous subcutaneous apomorphine infusion (CSAI), levodopa/ carbidopa intestinal gel (LCIG) infusion, and deep brain stimulation (DBS), have been found to decrease the intensity and frequency of motor fluctuations, improve non-motor aspects of PD and ameliorate the patients’ and their caregivers’ quality of life ( Dafsari et al, 2019 ; Santos-García, Añón, Fuster-Sanjurjo, & de la Fuente-Fernández, 2012 ), while some benefits are maintained in the long-term ( Antonini et al, 2021 ; Limousin & Foltynie, 2019 ). Although device-aided therapies, especially DBS, appear to be cost-effective in the long-term ( Smilowska et al, 2021 ), regular follow-up visits are still required, while the role of nursing care in the management of these patients, including home-visits, is essential ( Antonini, Mirò, Castiglioni, & Pezzoli, 2008 ; De Rosa, Tessitore, Bilo, Peluso, & De Michele, 2016 ).…”