期刊
MOVEMENT DISORDERS
卷 25, 期 10, 页码 1456-1463出版社
WILEY
DOI: 10.1002/mds.23111
关键词
Parkinson's disease; subthalamic deep brain stimulation; decision analysis; utilities; Markov; Monte-Carlo simulation
资金
- Medtronic
- CleveMed
- Davis Phinney Foundation
- Michael J Fox Foundation
- NIH
- Canadian Institutes of Health Research
- Foundation for Informed Medical Decision Making
- National Institute of Diabetes and Digestive and Kidney Diseases [K23 DK075599]
- National Heart, Lung, and Blood Institute [K30 HL078581-01]
- NIH/NCRR [1U54 RR 025216]
- National Library of Medicine [LM009533]
- Gilead Sciences, Inc.
The long-term benefits of subthalamic nucleus deep brain stimulation (STN DBS) applied earlier in the disease course, before significant disability accumulates, remain to be determined. We developed a Markov state transition decision analytic model to compare effectiveness in quality-adjusted life years (QALYs) of STN DBS applied to patients with PD at an early (off time 10-20%) versus delayed stage (off time >40%). A lifelong time horizon and societal perspective were assumed. Probabilities and rates were obtained from literature review; utilities were derived using the time trade-off technique and a computer-assisted utility assessment software tool applied to a cohort of 22 STN-DBS and 21 non-STN-DBS PD patients. Uncertainty was assessed through one- and two-way sensitivity analyses and probabilistic sensitivity analysis using second-order Monte Carlo simulations. Early STN DBS was preferred with a quality-adjusted life expectancy of 22.3 QALYs, a gain of 2.5 QALYs over those with delayed surgery (19.8 QALYs). Early STN DBS was preferred in 69% of 5,000 Monte Carlo simulations. Early surgery was robustly favored through most sensitivity analyses. Delayed STN DBS afforded greater QALYs when using utility estimates exclusively from non-STN-DBS patients and, for the entire group, if the rate of motor progression were to exceed 25% per year. Although decision modeling requires assumptions and simplifications, our exploratory analysis suggests that STN DBS performed in early PD may convey greater quality-adjusted life expectancy when compared to a delayed procedure. These findings support further evaluation of early STN DBS in a controlled clinical trial. (C) 2010 Movement Disorder Society
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