Cost‐effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor

Ravikumar, Vinod K; Parker, Jonathon J.; Hornbeck, Traci; Santini, Veronica; Pauly, Kim Butts; Wintermark, Max; Ghanouni, Pejman; Stein, Sherman C.; Halpern, Casey H.

doi:10.1002/mds.26997

Cited by 85 publications

(61 citation statements)

References 50 publications

(93 reference statements)

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“…Country‐specific differences in costs of course would still need to be taken into account when generalizing our findings to other settings. To our knowledge, there is only one published study that examined the cost‐effectiveness of MRgFUS for ET in the United States, which found similar overall results . There is a need for more economic evidence to inform the resource allocation decisions of payers in many jurisdictions.…”

Section: Discussionmentioning

confidence: 92%

“…To our knowledge, there is only one published study that examined the costeffectiveness of MRgFUS for ET in the United States, which found similar overall results. 18 There is a need for more economic evidence to inform the resource allocation decisions of payers in many jurisdictions. Ravikumar et al compared MRgFUS with DBS (staged and unstaged) and stereotactic radiosurgery (such as gamma knife).…”

Section: Discussionmentioning

confidence: 99%

“…Improvement postsurgery : The proportions of patients with marked or mild to moderate improvement after MRgFUS were obtained from Elias et al, the only randomized clinical trial comparing MRgFUS with sham . Because comparative data of MRgFUS against other surgeries are scant and studies of DBS and RF are mostly uncontrolled observational studies, it is difficult to generate reliable comparative effectiveness of MRgFUS versus other surgeries. In general, studies comparing different surgeries have not shown a significant difference between treatments .…”

Section: Methodsmentioning

confidence: 99%

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Cost‐Effectiveness of Magnetic Resonance‐Guided Focused Ultrasound for Essential Tremor

Gajić-Veljanoski

Schaink

et al. 2018

Movement Disorders

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Background Radiofrequency thalamotomy and deep brain stimulation are current treatments for moderate to severe medication‐refractory essential tremor. However, they are invasive and thus carry risks. Magnetic resonance‐guided focused ultrasound is a new, less invasive surgical option. The objective of the present study was to determine the cost‐effectiveness of magnetic resonance‐guided focused ultrasound compared with standard treatments in Canada. Methods We conducted a cost‐utility analysis using a Markov cohort model. We compared magnetic resonance‐guided focused ultrasound with no surgery in people ineligible for invasive neurosurgery and with radiofrequency thalamotomy and deep brain stimulation in people eligible for invasive neurosurgery. In the reference case analysis, we used a 5‐year time horizon and a public payer perspective and discounted costs and benefits at 1.5% per year. Results Compared with no surgery in people ineligible for invasive neurosurgery, magnetic resonance‐guided focused ultrasound cost $21,438 more but yielded 0.47 additional quality‐adjusted life years, producing an incremental cost‐effectiveness ratio of $45,817 per quality‐adjusted life year gained. In people eligible for invasive neurosurgery, magnetic resonance‐guided focused ultrasound was slightly less effective but much less expensive compared with the current standard of care, deep brain stimulation. The results were sensitive to assumptions regarding the time horizon, cost of magnetic resonance‐guided focused ultrasound, and probability of recurrence. Conclusions In people ineligible for invasive neurosurgery, the incremental cost‐effectiveness ratio of magnetic resonance‐guided focused ultrasound versus no surgery is comparable to many other tests and treatments that are widely adopted in high‐income countries. In people eligible for invasive neurosurgery, magnetic resonance‐guided focused ultrasound is also a reasonable option. © 2018 International Parkinson and Movement Disorder Society

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Cost‐Effectiveness of Magnetic Resonance‐Guided Focused Ultrasound for Essential Tremor

Gajić-Veljanoski

Schaink

et al. 2018

Movement Disorders

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“…Recently, the addition of MRI-guided high-intensity focused ultrasound (MRIgFUS)19 has again stimulated interest in this field,20 21 as it offers an incisionless approach to create an intracerebral lesion under direct imaging-control in a stepwise manner 22–25. First data comparing surgical interventions by DBS, GK and MRIgFUS indicate better functional disability improvement with MRIgFUS over DBS and GK, while incisionless approaches show better cost-effectiveness 26. One could therefore say that these technological advances lead to a renaissance of lesional functional neurosurgery.…”

Section: Introductionmentioning

confidence: 99%

Functional lesional neurosurgery for tremor: a systematic review and meta-analysis

Schreglmann

Krauss

Chang

et al. 2018

J Neurol Neurosurg Psychiatry

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“…This emerging technology is used primarily for thermal ablation of central brain locations, such as for the treatment of essential tremor and Parkinson's disease. 5,21,41,50 MRg-FUS is an image-guided, noninvasive treatment option that can be used to manipulate the BBB and achieve focal CNS tumor drug delivery of systemically administered treatments. …”

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confidence: 99%

A review of potential applications of MR-guided focused ultrasound for targeting brain tumor therapy

Lamsam¹,

Johnson²,

Connolly³

et al. 2018

Neurosurgical Focus

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Magnetic resonance–guided focused ultrasound (MRgFUS) has been used extensively to ablate brain tissue in movement disorders, such as essential tremor. At a lower energy, MRgFUS can disrupt the blood-brain barrier (BBB) to allow passage of drugs. This focal disruption of the BBB can target systemic medications to specific portions of the brain, such as for brain tumors. Current methods to bypass the BBB are invasive, as the BBB is relatively impermeable to systemically delivered antineoplastic agents. Multiple healthy and brain tumor animal models have suggested that MRgFUS disrupts the BBB and focally increases the concentration of systemically delivered antitumor chemotherapy, immunotherapy, and gene therapy. In animal tumor models, combining MRgFUS with systemic drug delivery increases median survival times and delays tumor progression. Liposomes, modified microbubbles, and magnetic nanoparticles, combined with MRgFUS, more effectively deliver chemotherapy to brain tumors. MRgFUS has great potential to enhance brain tumor drug delivery, while limiting treatment toxicity to the healthy brain.

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Cost‐effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor

Cited by 85 publications

References 50 publications

Cost‐Effectiveness of Magnetic Resonance‐Guided Focused Ultrasound for Essential Tremor

Cost‐Effectiveness of Magnetic Resonance‐Guided Focused Ultrasound for Essential Tremor

Functional lesional neurosurgery for tremor: a systematic review and meta-analysis

A review of potential applications of MR-guided focused ultrasound for targeting brain tumor therapy

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