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Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis
Keyvan Mirsaeedi-Farahani1, C H Halpern, G H Baltuch
1Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421 (6th floor), Philadelphia, PA, 19104, USA, keyvanm@mail.med.upenn.edu.
Journal of Neurology
|March 6, 2015
Summary
Deep brain stimulation (DBS) shows promise for Alzheimer disease (AD) memory improvement. Cost-effectiveness analysis suggests DBS is viable for mild AD if success rates are relatively low, offering a potential new treatment avenue.
Area of Science:
- Neuroscience
- Medical Technology
- Health Economics
Background:
- Alzheimer disease (AD) significantly impairs memory, with current treatments offering limited benefits.
- Emerging research suggests deep brain stimulation (DBS) may enhance memory function in AD patients.
Purpose of the Study:
- To determine the clinical and economic thresholds for deep brain stimulation (DBS) to be as effective as standard Alzheimer disease (AD) treatment.
- To evaluate the cost-effectiveness of DBS for mild-stage AD.
Main Methods:
- A 5-year decision analysis model was developed comparing standard AD therapy to theoretical DBS treatment.
- Data on AD progression, quality of life (QoL), and costs were sourced from literature reviews.
- The model analyzed cumulative QoL (in quality-adjusted life years - QALYs) and costs under various DBS success rates, considering complication rates.
Main Results:
- DBS for mild AD requires a 3% success rate to offset potential QoL impacts from surgical complications.
- DBS becomes cost-effective for mild AD at success rates above 20% ($200K/QALY) or 74% ($50K/QALY).
- Success rates exceeding 80% render DBS both clinically superior and more cost-effective than standard AD treatment.
Conclusions:
- The clinical and economic thresholds for deep brain stimulation (DBS) to be cost-effective in treating Alzheimer disease (AD) are attainable.
- DBS presents a potentially viable and cost-effective therapeutic option for improving memory in mild-stage AD.
- Further research into DBS efficacy and implementation for AD is warranted.
