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RESEARCH ARTICLE
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The treatment gap for deep brain stimulation in Parkinson’s disease: a comparative analysis of cost and utilisation in high-income countries

Athena Stein A B * , Nathan Higgins C , Mehul Gajwani https://orcid.org/0000-0002-7195-6822 C and Christian A. Gericke A D
+ Author Affiliations
- Author Affiliations

A School of Public Health, The University of Queensland, Herston, Qld, Australia.

B The University of Queensland Child Health Research Centre, South Brisbane, Qld, Australia.

C The Turner Institute for Brain and Mental Health and Monash Biomedical Imaging, Monash University, Clayton, Vic, Australia.

D School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.

* Correspondence to: a.stein@uq.edu.au

Australian Health Review https://doi.org/10.1071/AH24036
Submitted: 8 February 2024  Accepted: 23 August 2024  Published: 16 September 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Objective

Parkinson’s disease (PD) is one of the most prevalent neurodegenerative disorders, globally affecting approximately 120 per 100,000 people by age 70. Deep brain stimulation (DBS) is a US Federal Drug Administration (FDA)-approved and highly effective treatment for late-stage PD. However, country-specific reimbursement regulations and health policies may affect access to PD-DBS. We aimed to evaluate the uptake rate and ‘treatment gap’ for DBS across high-income countries.

Methods

We reviewed previous literature to investigate the cost and utilisation of PD-DBS in high-income countries across Asia, Europe, Oceania, and North America (Australia, Canada, France, Germany, Hong Kong, Japan, Korea, the Netherlands, New Zealand, Norway, Spain, Switzerland, UK, and USA). Using previous estimates of DBS candidate eligibility rates, we calculated theoretical DBS uptake rates and treatment gaps nationally.

Results

PD-DBS utilisation was highest in Australia and the USA and lowest in Korea and New Zealand. The total cost of PD-DBS in the first 12 months was highest in the USA and France and lowest in the UK and Germany. The utilisation rate (i.e. uptake rate) of PD-DBS (% DBS surgeries per PD case) was highest in Australia and the USA, and lowest in New Zealand and the UK, where the treatment gap reflected these trends.

Conclusions

Our results highlight differences in access to DBS for PD patients among high-income countries, which we discuss in the context of health systems. Better access to effective PD treatments such as DBS is critical given the increasing prevalence of PD in an ageing world and the associated, avoidable morbidity.

Keywords: comparative analysis, cost, DBS, deep-brain stimulation, movement disorders, Parkinson’s disease, treatment gap, utilisation.

References

1  Dams J, Siebert U, Bornschein B, et al. Cost‐effectiveness of deep brain stimulation in patients with Parkinson’s disease. Mov Disord 2013; 28: 763-771.
| Crossref | Google Scholar | PubMed |

2  Dauer W, Przedborski S. Parkinson’s disease: Mechanisms and models. Neuron 2003; 39: 889-909.
| Crossref | Google Scholar | PubMed |

3  Rizek P, Kumar N, Jog MS. An update on the diagnosis and treatment of Parkinson’s disease. CMAJ 2016; 188: 1157-1165.
| Crossref | Google Scholar | PubMed |

4  Beitz JM. Parkinson’s disease: a review. Front Biosci 2014; 6: 65-74.
| Crossref | Google Scholar | PubMed |

5  Reider CR, Halter CA, Castelluccio PF, et al. Reliability of reported age at onset for Parkinson’s disease. Mov Disord 2003; 18: 275-279.
| Crossref | Google Scholar | PubMed |

6  Macleod AD, Taylor KS, Counsell CE. Mortality in Parkinson’s disease: a systematic review and meta‐analysis. Move Disord 2014; 29: 1615-1622.
| Crossref | Google Scholar | PubMed |

7  Xia R, Mao Z-H. Progression of motor symptoms in Parkinson’s disease. Neurosci Bull 2012; 28: 39-48.
| Crossref | Google Scholar | PubMed |

8  Rezak M. Current pharmacotherapeutic treatment options in Parkinson’s disease. Dis Mon 2007; 53: 214-222.
| Crossref | Google Scholar | PubMed |

9  Nestor KA, Jones JD, Butson CR, et al. Coordinate-based lead location does not predict Parkinson’s disease deep brain stimulation outcome. PLoS One 2014; 9: e93524.
| Crossref | Google Scholar | PubMed |

10  Benabid AL. Deep brain stimulation for Parkinson’s disease. Curr Opin Neurobiol 2003; 13: 696-706.
| Crossref | Google Scholar | PubMed |

11  Deep-Brain Stimulation for Parkinson’s Disease Study Group.. Deep brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med 2001; 345: 956-963.
| Crossref | Google Scholar | PubMed |

12  Collins KL, Lehmann EM, Patil PG. Deep brain stimulation for movement disorders. Neurobiol Dis 2010; 38: 338-345.
| Crossref | Google Scholar | PubMed |

13  Wu H, Hariz M, Visser-Vandewalle V, et al. Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy? Mol Psychiatry 2021; 26: 60-65.
| Crossref | Google Scholar | PubMed |

14  Fitzgerald PB, Segrave RA. Deep brain stimulation in mental health: Review of evidence for clinical efficacy. Aust N Z J Psychiatry 2015; 49: 979-993.
| Crossref | Google Scholar | PubMed |

15  Hariz M. My 25 stimulating years with DBS in Parkinson’s disease. J Parkinsons Dis 2017; 7: S33-S41.
| Crossref | Google Scholar | PubMed |

16  IHME. Global burden of disease database. Seattle, WA: University of Washington; 2017.

17  Limousin P, Krack P, Pollak P, et al. Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 1998; 339: 1105-1111.
| Crossref | Google Scholar | PubMed |

18  Capecci M. Functional improvement after subthalamic stimulation in Parkinson’s disease: a non-equivalent controlled study with 12-24 month follow up. J Neurol Neurosurg Psychiatry 2005; 76: 769-774.
| Crossref | Google Scholar | PubMed |

19  Morgante L, Morgante F, Moro E, et al. How many parkinsonian patients are suitable candidates for deep brain stimulation of subthalamic nucleus? Results of a questionnaire. Parkinsonism Relat Disord 2007; 13: 528-531.
| Crossref | Google Scholar | PubMed |

20  Medical Services Advisory Committee. Deep brain stimulation for the symptoms of Parkinson’s disease. In: Department of Health and Ageing, editor. Canberra: Commonwealth of Australia; 2006.

21  Turner HC, Lauer JA, Tran BX, et al. Adjusting for inflation and currency changes within health economic studies. Value Health 2019; 22: 1026-1032.
| Crossref | Google Scholar | PubMed |

22  Schiess N, Cataldi R, Okun MS, et al. Six Action Steps to Address Global Disparities in Parkinson Disease: A World Health Organization Priority. JAMA Neurol 2022; 79: 929.
| Crossref | Google Scholar | PubMed |

23  Vedam-Mai V, Deisseroth K, Giordano J, et al. Proceedings of the eighth annual deep brain stimulation think tank: advances in optogenetics, ethical issues affecting DBS research, neuromodulatory approaches for depression, adaptive neurostimulation, and emerging DBS technologies. Front Hum Neurosci 2021; 15: 644593.
| Crossref | Google Scholar |

24  Pluta RM, Perazza GD, Golub RM. Deep brain stimulation. JAMA 2011; 305: 732.
| Crossref | Google Scholar | PubMed |

25  Lang AE, Widner H. Deep brain stimulation for Parkinson’s disease: Patient selection and evaluation. Mov Disord 2002; 17: S94-S101.
| Google Scholar |

26  GBD 2016 Parkinson’s Disease Collaborators.. Global, regional, and national burden of Parkinson’s disease, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018; 17: 939-953.
| Crossref | Google Scholar | PubMed |

27  Abbas MM, Xu Z, Tan LC. Epidemiology of Parkinson’s disease—East versus west. Mov Disord Clin Pract 2018; 5: 14-28.
| Crossref | Google Scholar | PubMed |

28  Hindle JV. Ageing, neurodegeneration and Parkinson’s disease. Age Ageing 2010; 39: 156-161.
| Crossref | Google Scholar | PubMed |

29  Singh SR. Public Health Spending and Population Health: A Systematic Review. Am J Prev Med 2014; 47: 634-640.
| Crossref | Google Scholar | PubMed |

30  Papanicolas I, Mossialos E, Gundersen A, et al. Performance of UK National Health Service compared with other high income countries: observational study. BMJ 2019; 367: l6326.
| Crossref | Google Scholar | PubMed |

31  Tikkanen R. Multinational Comparisons of Health Systems Data, 2019. The Commonwealth Fund; 2017.

32  Bronstein JM, Tagliati M, Alterman RL, et al. Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol 2011; 68: 165.
| Crossref | Google Scholar | PubMed |

33  Marks WJ, Ostrem JL. Deep brain stimulation management. Cambridge University Press; 2022.

34  Lee J-I. The current status of deep brain stimulation for the treatment of Parkinson’s disease in the Republic of Korea. J Mov Disord 2015; 8: 115.
| Crossref | Google Scholar | PubMed |

35  Ezat B, Pihlstrøm L, Aasly J, et al. Use of advanced therapies for Parkinson’s disease in Norway. Tidsskr Nor Laegeforen 2017; 137: 619-623.
| Crossref | Google Scholar | PubMed |

36  The World Bank. Population ages 65 and above (% of total population). United Nations Population Division’s World population prospects: 2019 revision. Washington, DC: World Bank Group; 2019.

37  Gardner J. A history of deep brain stimulation: Technological innovation and the role of clinical assessment tools. Soc Stud Sci 2013; 43: 707-728.
| Crossref | Google Scholar |

38  Department of Health and Aged Care. Use of market authorisation evidence from comparable overseas regulators/assessment bodies for medical devices (including IVDs). 2021. Available at https://www.tga.gov.au/

39  Australian Institute of Health and Welfare. Patients’ out-of-pocket spending on Medicare services, 2016–17. Australian Government; 2018.

40  OECD. Health spending. Paris: OECD Publishing; 2020.

41  Parkinson’s Victoria. Response to the out-of-pocket costs in Australian healthcare impacting on people living with movement disorders. Melbourne: Parliament of Australia; 2014.

42  Mosley P. Application No. 1727 Deep brain stimulation for treatment refractory obsessive-compulsive disorder. MSAC Application 1727. 2023. Available at http://www.msac.gov.au/

43  Siddiqui JH, Bhatti D, Alsubaie F, Bajwa JA. Movement Disorders and Deep Brain Stimulation in the Middle East. World Neurosurg 2018; 113: e314-e319.
| Crossref | Google Scholar | PubMed |

44  Hell F, Palleis C, Mehrkens JH, et al. Deep brain stimulation programming 2.0: future perspectives for target identification and adaptive closed loop stimulation. Front Neurol 2019; 10: 314.
| Crossref | Google Scholar | PubMed |

45  Lozano CS, Tam J, Lozano AM. The changing landscape of surgery for Parkinson’s Disease. Mov Disord 2018; 33: 36-47.
| Crossref | Google Scholar | PubMed |

46  Zhang C, Ramirez-Zamora A, Meng F, et al. An International Survey of Deep Brain Stimulation Utilization in Asia and Oceania: The DBS Think Tank East. Front Hum Neurosci 2020; 14: 162.
| Crossref | Google Scholar | PubMed |