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

Abstract

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

4D printing of soft orthoses for tremor suppression

“…Almost half of the individuals with ET who take this medication exhibited recurrent tremors or insufficient improvement in tremors, intense adverse effects, or contraindications to the medicine [18]. Another study revealed that propranolol and primidone can cost about $269 annually (assuming that people take both medications) [19]. Dopamine-based drugs such as levodopa, dopamine agonists, or monoamine oxidase-B have been prescribed for PD patients, although side effects like nausea and dizziness have been reported [20].…”

A preclinical study of diffusion‐weighted MRI contrast as an early indicator of thermal ablation

“…5 The T-MRgFUS method is completely noninvasive and offers potential advantages in patient morbidity, recovery time, and procedural costs over invasive treatments such as deep brain stimulation. 6,7 However, as pointed out in Boutet et al, 8 essential tremor symptom reductions after T-MRgFUS do not reach the same levels of efficacy as deep brain stimulation. There is a critical need to improve treatment efficacy and durability by ensuring that permanent tissue necrosis occurs within the entire ablation target.…”

“…A multicenter pivotal trial has recently led to US Food and Drug Administration approval for this surgery 5 . The T‐MRgFUS method is completely noninvasive and offers potential advantages in patient morbidity, recovery time, and procedural costs over invasive treatments such as deep brain stimulation 6,7 . However, as pointed out in Boutet et al, 8 essential tremor symptom reductions after T‐MRgFUS do not reach the same levels of efficacy as deep brain stimulation.…”

Technical Principles and Clinical Workflow of Transcranial MR-Guided Focused Ultrasound

“…Owing to the appeal and potential benefits of less-invasive surgical techniques, MRgFUS thermoablation has superseded previously developed lesioning approaches at many institutions, particularly for unilateral thalamotomy in the treatment of medication-refractory essential tremor (ET) [4-6]. With demonstration of the cost-effectiveness of transcranial MRgFUS relative to standard surgical treatments for ET, this trend is poised to continue for other intracranial ablative indications [7, 8]. Additionally, low-intensity pulsed FUS and circulating microbubbles can increase blood-brain barrier (BBB) permeability to enable localized drug delivery to the CNS and is a burgeoning field of clinical research built on a promising line of preclinical investigations since the initial feasibility was demonstrated in 2001 [9-15].…”