| Summary: | 碩士 === 國立臺灣大學 === 會計與管理決策組 === 100 === Background and propose:
Parkinson’ disease (PD) is one of the most common neurological diseases in elderly. The clinical manifestations of PD are resting tremor, bradykinesia, rigidity and postural instability. Antiparkinsonism agents such as levodpar and doperminergic agonists are widely
used for treatment of PD. However, dyskinesia and fluctuation may develop after long-term medication treatment. Subthalamic nucleus deep brain stimulation (STN-DBS) by stereotaxic surgery is one of alternative treatments of PD. Although STN-DBS is an expensive procedure, clinical reports have proved the effectiveness of STN-DBS in PD. In this study, we evaluate the long-term cost-effectiveness between medication and STN-DBS for PD in Taiwan.
Materials and methods:
We divided patients with PD into three treatment groups: medication, STN-DBS and delayed treatment groups. We searched the published articles by the key words of Parkinson’s disease, deep brain stimulation, subthalamus, randomized clinical trail form PubMed data base. We collected the information of treatment responses such as unified Parkinson disease rating score (UPDRS) motor score, Hoehn-Yahr (H-Y) stage, activity of daily life (ADL), dyskinesia and survival results in different follow-up intervals as the effectiveness parameters. We searched for the expense of medication or surgical procedure form National Health Insurance as the parameters of cost for PD. The probabilistic economic evaluation with Markov decision model was used to simulate the natural history of PD by H-Y stage. As a measure of long-term cost-effectiveness, we calculated the incremental cost-effectiveness ratio (ICER), incremental net benefit index, number need to treatment and life years gained adjusted by healthrelated quality of life (QALY).
Results:
In the three years follow-up period, the UPDRS scores were 53.24 in delayed treatment group which was higher than 19.73 of STN-DBS and 36.71 of medication groups. As compared with delayed treatment group, the ADL improved 39% in STN-DBS and 33% in mediation groups. The survival rates were decreased to 67% (95%CI: 65.96%-67.55%) in STN-DBS and 34% (95%CI: 33.15%-34.51%) in medication groups as compared with delayed treatment group. The cost-effectiveness analysis revealed cost of 128,567 USD in STN-DBS, 115,119 USD in medication and 169,777 USDin delayed treatment groups based on thirty thousand patients with PD with long-term follow-up for 10 years. Comparing the ICER needed to
obtain an improvement of one point in the UPDRS score with delayed treatment group, both STN-DBS and medication groups were cost-saving strategy. In comparing with medication group, the ICER needed to obtain an improvement of one oint in the UPDRS score was of 903 USD in STN-DBS patients. Both STN-DBS and medication groups were cost-saving strategy for improving of QALY than delayed treatment group. In comparing with medication group, for improving one QALY was of 7,994 USD in STN-DBS patients. The STN-DBS group has higher probability of cost-effectiveness than medication group when the cost of will-to-pay more than 10,000 USD.
Conclusion:
STN-DBS group can save 113,487 life-year than delayed treatment group and 47,694 life-year than medication group. DBS-STN group is more cost effectiveness than delayed treatment group. The STN-DBS group has higher probability of cost-effectiveness than medication group when the cost of will-to-pay more than 10,000 USD.
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