Posteroventral pallidotomy for Parkinson's disease: assessment and policy on a technology in transition

Posteroventral pallidotomy (PVP) is a neurosurgical technique used in the management of persons with Parkinson's Disease whose symptoms can no longer be controlled by medical treatment. There is pressure on policy areas to provide support for this intervention. An assessment of the status of the technology concluded that the available evidence of efficacy of PVP was only fair to poor, and that the technology was continuing to evolve. Nevertheless, it was suggested that support for PVP, linked to collection of outcomes data, would be justified, taking account of the morbidity and poor quality of life for this type of patient, and limitations of alternative methods of management. This case study provides an example of the dilemmas facing policy areas in dealing with evolving technology, with limited available evidence and with the prospect of further management options becoming available.