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A Novel Approach to Assess Motor Outcome of Deep Brain Stimulation Effects in the Hemiparkinsonian Rat: Staircase and Cylinder Test
Published on: May 31, 2016
Early versus delayed bilateral subthalamic deep brain stimulation for parkinson's disease: a decision analysis
Alberto J Espay1, Jennifer E Vaughan, Connie Marras
1Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio 45267-0525, USA. alberto.espay@uc.edu
Summary
Early subthalamic nucleus deep brain stimulation (STN DBS) for Parkinson's disease (PD) may offer greater quality-adjusted life expectancy compared to delayed surgery. This approach yielded a significant gain in quality-adjusted life years (QALYs).
Area of Science:
- Neurology
- Medical Economics
- Decision Science
Background:
- The long-term benefits of early subthalamic nucleus deep brain stimulation (STN DBS) in Parkinson's disease (PD) are not fully understood.
- Current practice often delays STN DBS until significant disability has occurred.
Purpose of the Study:
- To compare the effectiveness, measured in quality-adjusted life years (QALYs), of early versus delayed STN DBS in patients with PD.
- To inform clinical decision-making regarding the optimal timing for STN DBS intervention.
Main Methods:
- Development of a Markov state transition decision analytic model with a lifelong time horizon and societal perspective.
- Probabilities and rates sourced from literature review; utilities derived from patient assessments using time trade-off technique and specialized software.
- Uncertainty assessed via sensitivity analyses and Monte Carlo simulations.
Main Results:
- Early STN DBS was associated with a higher quality-adjusted life expectancy (22.3 QALYs) compared to delayed STN DBS (19.8 QALYs), a gain of 2.5 QALYs.
- Early STN DBS was favored in 69% of probabilistic sensitivity analyses.
- Sensitivity analyses indicated early surgery was generally robustly favored, with exceptions under specific utility or motor progression rate assumptions.
Conclusions:
- Decision modeling suggests that performing STN DBS earlier in the course of PD may lead to greater quality-adjusted life expectancy.
- These findings support the need for further investigation of early STN DBS in controlled clinical trials.
