Evidence map›Paper›PMID 27441637›Full record

ArticlePloS one2016

Deep Brain Stimulation for Parkinson's Disease with Early Motor Complications: A UK Cost-Effectiveness Analysis.

Tomasz Fundament, Paul R Eldridge, Alexander L Green, Alan L Whone, Rod S Taylor, Adrian C Williams, W M Michael Schuepbach

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 6 pooled it
3.4field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 6 syntheses or guidelines pooled it, 48 citations in OpenAlex.

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  19. Telemedicine in Neurological Disorders: Opportunities and Challenges.Telemedicine journal and e-health : the official journal of the American Telemedicine Association · 2019
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 7 institutions in 4 countries.

Tomasz FundamentHTA Consulting, Krakow, Poland.
Paul R EldridgeThe Walton Centre NHS Foundation Trust and Liverpool University, Liverpool, United Kingdom.
Alexander L GreenNuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
Alan L WhoneBristol Brain Centre, Southmead Hospital, Bristol, United Kingdom.
Rod S TaylorUniversity of Exeter Medical School, Exeter, United Kingdom.
Adrian C WilliamsUniversity Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
W M Michael SchuepbachMovement Disorders Center, Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
CRE Consulting (Poland) · PLSouthmead Hospital · GBUniversity Hospitals Birmingham NHS Foundation Trust · GBUniversity of Bern · CHUniversity of Exeter · GBUniversity of Liverpool · GBUniversity of Oxford · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundParkinson's disease (PD) is a debilitating illness associated with considerable impairment of quality of life and substantial costs to health care systems. Deep brain stimulation (DBS) is an established surgical treatment option for some patients with advanced PD. The EARLYSTIM trial has recently demonstrated its clinical benefit also in patients with early motor complications. We sought to evaluate the cost-effectiveness of DBS, compared to best medical therapy (BMT), among PD patients with early onset of motor complications, from a United Kingdom (UK) payer perspective.

methodsWe developed a Markov model to represent the progression of PD as rated using the Unified Parkinson's Disease Rating Scale (UPDRS) over time in patients with early PD. Evidence sources were a systematic review of clinical evidence; data from the EARLYSTIM study; and a UK Clinical Practice Research Datalink (CPRD) dataset including DBS patients. A mapping algorithm was developed to generate utility values based on UPDRS data for each intervention. The cost-effectiveness was expressed as the incremental cost per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were undertaken to explore the effect of parameter uncertainty.

resultsOver a 15-year time horizon, DBS was predicted to lead to additional mean cost per patient of £26,799 compared with BMT (£73,077/patient versus £46,278/patient) and an additional mean 1.35 QALYs (6.69 QALYs versus 5.35 QALYs), resulting in an incremental cost-effectiveness ratio of £19,887 per QALY gained with a 99% probability of DBS being cost-effective at a threshold of £30,000/QALY. One-way sensitivity analyses suggested that the results were not significantly impacted by plausible changes in the input parameter values.

conclusionThese results indicate that DBS is a cost-effective intervention in PD patients with early motor complications when compared with existing interventions, offering additional health benefits at acceptable incremental cost. This supports the extended use of DBS among patients with early onset of motor complications.

Indexed as

Cost-Benefit AnalysisMotor ActivityDeep Brain StimulationHumansMiddle AgedModels, TheoreticalParkinson DiseaseProbabilityQuality-Adjusted Life YearsQuality of LifeUnited Kingdom

Identifiers

PMID27441637
PMCPMC4956248
OpenAlexW2506692147

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.