Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis

Abstract

Alzheimer disease (AD) is characterized by impairments in memory function. Standard AD treatment provides marginal improvements in this domain. Recent reports, however, suggested that deep brain stimulation (DBS) may result in improved memory. Given significant equipment costs and health expenses required for DBS surgery, we determine clinical and economic thresholds required for it to be as effective as standard AD treatment. Literature review yielded annual AD progression probabilities, health-related quality of life (QoL), and costs by AD stage. Our 5-year decision analysis model compared cumulative QoL in quality-adjusted life years (QALYs) and costs of standard therapy to theoretical DBS treatment of various success rates, using known complication rates and QoL data. The base case was a patient with mild-stage AD. DBS success was defined as regression to and maintenance of minimal stage AD, which was defined as midway between mild and no dementia, for the first year, and continuation of the natural course of AD for the remaining 4 years. Compared to standard treatment alone, DBS for mild-stage AD requires a success rate of 3% to overcome effects of possible surgical complications on QoL. If DBS can be delivered with success rates above 20% ($200 K/QALY) or 74% ($50 K/QALY) for mild AD, it can be considered cost-effective. Above a success rate of 80%, DBS treatment is both clinically more effective and more cost-effective than standard treatment. Our findings demonstrate that clinical and economic thresholds required for DBS to be cost-effective for AD are relatively low.

Effects of Deep Brain Stimulation on Autonomic Function

“…Deep brain stimulation (DBS) has evolved into a well-established therapy for Parkinson’s disease [ 1 ], essential tremor [ 2 ], and dystonia [ 2 ], as well as a therapy for multiple sclerosis [ 3 ], cluster headache [ 4 ], Tourette syndrome [ 5 ], and obsessive-compulsive disorder [ 6 ]. DBS is even being investigated as a surgical intervention for obesity, major depression, and a therapy for restoring memory to patients with Alzheimer disease [ 7 , 8 , 9 , 10 , 11 ]. In addition to the primary symptoms treated by DBS, many groups have investigated its effect on autonomic functions at various target sites in the brain [ 12 , 13 ].…”

The rationale for deep brain stimulation in Alzheimer’s disease

“…At a success rate of 20 %, DBS can be considered cost-effective for mild AD at the price of $200K per quality-adjusted life year (QALY), while at success rates of 74 %, that price drops to $50K/ QALY. Above 80 % success rate, DBS is both clinically more effective and more cost-effective than standard treatment (Mirsaeedi-Farahani et al 2015). Indeed, phase I trials of DBS for AD, targeting either the fornix (Laxton et al 2010) or NBM (Kuhn et al 2015), have shown that DBS is safe and well tolerated in AD patients, with promising early data for cognitive improvement.…”

“…It is associated with significant costs to the individual and society. A recent cost-effectiveness study found that the clinical and economic thresholds required for DBS to be considered cost-effective for AD are relatively low (Mirsaeedi-Farahani et al 2015). Compared to standard treatment, DBS needs only a success rate of 3 % to overcome effects of potential surgical complications on quality of life.…”

Deep brain stimulation for Alzheimer's Disease: An update

“…A cost-effectiveness study found that the clinical and economic thresholds required for DBS to be considered cost-effective for AD are relatively low. [ 27 ] Compared to standard treatment, DBS needs a success rate of only 3% to overcome effects of potential surgical complications on quality of life. At a success rate of 20%, DBS can be considered cost-effective for mild AD.…”