Cost-effectiveness of deep brain stimulation versus
treatment as usual for obsessive-compulsive disorder
Pieter Ooms1, Matthijs Blankers1,2,3, Martijn Figee1,, Isidoor O. Bergfeld1,, Pepijn van den Munckhof5, P. Richard Schuurman5 and Damiaan Denys1,6
1Department
of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands,
Arkin Mental Health Care, Amsterdam, the Netherlands
3 Trimbos institute, Utrecht, the Netherlands,
5Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,
6Netherlands institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
2
P.4.d.003
Background
Results
Deep Brain Stimulation (DBS) is effective for obsessivecompulsive disorder (OCD), but requires expensive medical
procedures. Cost-effectiveness of DBS for OCD has
never been studied.
• Compared to TAU, DBS provides an additional
0.26 QALY (SD=0.16).
Objective
To perform the first economic evaluation of DBS in
comparison with treatment as usual (TAU) for therapy
refractory OCD.
• Median cost per QALY gained is estimated at
€141,446 for base-case, €115,916 for standard
care and €65,394 for the rechargeable scenario.
• Extending the time-horizon to four years results
in a median cost per QALY of €80,313 for basecase, €69,287 for standard care, and turned
out to be cost-saving at €4,678 per QALY for
the rechargeable scenario.
Methods
• We conducted a 2-year prospective,
open cost-effectiveness study, comparing DBS (n=17) with
treatment as usual (TAU) (n=11).
• The economic evaluation adopted a societal perspective,
including all healthcare costs, patients’ productivity costs
and Quality-Adjusted-Life-Years (QALYs).
• Three scenario’s were examined:
A) Base-case, or primary analysis
B) Standard care, without research and innovation costs
C) Rechargeable, in which we assume the use of a
rechargeable battery
•
All scenarios were extrapolated to four years to estimate
long-term cost-effectiveness.
Discussion
• Under a willingness to pay threshold of €80,000
per QALY, DBS, under base-case and standard
care had 25% and 35% probability of being
more cost-effective than TAU.
• The rechargeable scenario and in all scenarios
extrapolated to four years, the probability of
cost-effectiveness was equal or higher than
TAU.
• This study indicates DBS for OCD is costeffective in the long-term, especially when
rechargeable batteries are taken into account.
Figure 2: Symptom severity (A)
and Quality of Life (B) over time
Figure 1: Cost-effectiveness planes and cost-effectiveness accessibility
curve of base-case, standard care, rechargeable and long term scenarios
Legend:
Cost-effectiveness planes based on 5,000 bootstrapped replications of the ICER of DBS compared to TAU. The gray
diagonal line indicates a willingness to pay (WTP) of €80,000 per QALY
The cost-effectiveness acceptability curve shows the probability that DBS is more cost-effective than TAU, given the
threshold WTP value (x-axis) for an extra QALY. The CEAC was drawn based on the distributions of ICERs over the cost
effectiveness plane. The indifference point is reached at a probability of 0.5 on the y-axis.
Legend: Y-BOCS: Yale-brown Obsessive Compuslive Scale; EQ-5d
score ranges from 0 to 1, EQ-5d score of 1 indicates a perfect health
state; DBS: Deep Brain Stimulation; TAU: Treatment as usual,
Errorbars indicate standard deviation.
Disclosure of Conflicts Of Interest:
Corresponding author:
Pieter Ooms | [email protected]
The department of psychiatry (Denys) received Medtronic devices
for research purposes. Schuurman is an independent consultant for
Medtronic on educational matters. All other authors do not declare
conflicts of interests.
Academic Medical Center, Department of Psychiatry,
PO Box 22660, 1100 DD Amsterdam, The Netherlands.
Telephone: +31 20 8913 600,
www.amcpsychiatrie.nl/research