Abstract

Background:

Despite optimal dopaminergic treatment most patients in moderate to advanced stages of Parkinson’s disease (PD) experience progressively increasing disabilities, necessitating a shift from oral medication to device-aided therapies, including deep brain stimulation (DBS), intrajejunal levodopa-carbidopa infusion (IJLI), and continuous subcutaneous apomorphine infusion (CSAI). However, these therapies are costly, limiting their implementation.

Objectives:

To perform a systematic review on cost-effectiveness analyses for device aided therapies in PD.

Methods:

A systematic review on cost-effectiveness analyses of these device-aided therapies in PD. References were identified by performing a systematic search in the PubMed and Web of Science databases in accordance with the PRISMA statement. In the absence of universal cost-effectiveness definitions, the gross domestic product per capita (GDP) in the country where study was performed was used as a cut-off for cost-effectiveness based on cost per quality adjusted life year (QALY) gained.

Results:

In total 28 studies were retrieved. All device-aided therapies improved quality of life compared to best medical treatment, with improvements in QALYs between 0.88 and 1.26 in the studies with long temporal horizons. For DBS, nearly all studies showed that cost per QALY was below the GDP threshold. For infusion therapies only three studies showed a cost per QALY below this threshold, with several studies with long temporal horizons showing costs below or near the GDP threshold.

Conclusion:

Of the device-aided therapies, DBS can be considered cost-effective, but the majority of infusion therapy studies showed that these were less cost-effective. However, long-term use of the infusion therapies appears to improve their cost-effectiveness and in addition, several strategies are underway to reduce these high costs.

中文翻译：

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帕金森病设备辅助治疗的成本效益：结构化审查

 抽象的

 背景：

尽管采用最佳的多巴胺能治疗，大多数中晚期帕金森病 (PD) 患者的残疾情况逐渐增加，需要从口服药物转向设备辅助治疗，包括深部脑刺激 (DBS)、空肠内左旋多巴-卡比多巴输注 (IJLI) ，以及连续皮下阿扑吗啡输注（CSAI）。然而，这些疗法成本高昂，限制了它们的实施。

 目标：

对 PD 设备辅助治疗的成本效益分析进行系统评价。

 方法：

对 PD 中这些设备辅助疗法的成本效益分析进行系统评价。根据 PRISMA 声明，通过在 PubMed 和 Web of Science 数据库中进行系统检索来确定参考文献。在缺乏通用成本效益定义的情况下，根据获得的每质量调整生命年（QALY）的成本，使用进行研究的国家的人均国内生产总值（GDP）作为成本效益的临界值。

 结果：

总共检索到 28 篇研究。与最佳药物治疗相比，所有设备辅助疗法均改善了生活质量，在长期研究中，QALY 改善在 0.88 至 1.26 之间。对于星展银行来说，几乎所有研究都表明每个 QALY 的成本低于 GDP 阈值。对于输注疗法，只有三项研究显示每个 QALY 的成本低于该阈值，而几项长期研究显示成本低于或接近 GDP 阈值。

 结论：

在设备辅助疗法中，DBS 可以被认为具有成本效益，但大多数输液治疗研究表明这些疗法的成本效益较低。然而，长期使用输注疗法似乎可以提高其成本效益，此外，正在采取几种策略来降低这些高成本。