MR-Guided Focused Ultrasound Versus Radiofrequency Capsulotomy for Treatment-Refractory Obsessive-Compulsive...

Area of Science:

• Neurosurgery
• Psychiatry
• Health Economics

Background:

• Neuroablative techniques are effective for treatment-refractory obsessive-compulsive disorder (OCD).
• Bilateral radiofrequency (RF) capsulotomy demonstrates efficacy, but MR-guided focused ultrasound (MRgFUS) capsulotomy is an emerging, potentially safer alternative.
• Existing data suggests MRgFUS has a favorable profile compared to RF ablation and radiosurgery.

Purpose of the Study:

• To evaluate the cost-effectiveness of MR-guided focused ultrasound (MRgFUS) capsulotomy compared to radiofrequency (RF) capsulotomy for obsessive-compulsive disorder (OCD).
• To identify critical clinical parameters influencing the cost-effectiveness of MRgFUS for OCD treatment.

Main Methods:

• A decision analytical model comparing MRgFUS and RF capsulotomy for OCD was developed.
• Outcome parameters included Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score improvement, complications, and side effects.
• Societal costs were derived from Medicare reimbursement rates, and effectiveness was based on published RF data.

Main Results:

• RF capsulotomy yielded an average Y-BOCS score reduction of 56.6% and a 22.6% improvement in quality of life.
• Complications occurred in 16.2% of RF cases, with 1.42% incurring additional hospitalization costs.
• MRgFUS was found to be more cost-effective than RF capsulotomy across various cost and complication rate scenarios.

Conclusions:

• MR-guided focused ultrasound (MRgFUS) capsulotomy presents a potentially safe and cost-effective treatment option for obsessive-compulsive disorder (OCD).
• MRgFUS may offer advantages over more invasive neuroablative techniques like RF capsulotomy.
• Further clinical trials are necessary to confirm the long-term safety and efficacy of MRgFUS for OCD.