Cost-Effectiveness Analysis of Deep Brain Stimulation for Parkinson's Disease in Türkiye
Cost-Effectiveness Analysis of Deep Brain Stimulation for Parkinson's Disease in Türkiye
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Original abstract
Abstract Background Deep brain stimulation (DBS) represents a transformative neurosurgical intervention for advanced Parkinson’s disease (PD), providing profound clinical relief where standard pharmacotherapy fails. However, the formidable upfront procedural and device investments demand rigorous economic justification to ensure sustainable patient access. To empower evidence-based neurosurgical practice, this study comprehensively evaluates the long-term cost-effectiveness of DBS combined with medical therapy (MT) versus MT alone from the Turkish healthcare payer perspective. Methods A Markov cohort simulation modeled the clinical trajectory of advanced PD over a lifetime horizon. Direct medical costs and quality-adjusted life years (QALYs) were discounted at 3% annually. Parameter uncertainty was evaluated through deterministic one-way and 10,000-iteration probabilistic sensitivity analyses. Results Discounted lifetime costs were $18,520 for DBS and $3,303 for MT, generating 3.61 and 1.93 QALYs, respectively. This yielded an incremental cost of $15,217 and a clinical benefit of 1.68 QALYs. The resulting incremental cost-effectiveness ratio (ICER) of $9,058 per QALY gained falls securely below national willingness-to-pay thresholds. Sensitivity analyses confirmed robust stability, identifying upfront device and surgical investments as the principal ICER drivers. Conclusions Despite formidable upfront surgical and device investments, the profound neuromodulatory efficacy and sustained reduction in pharmacological reliance establish DBS as a highly cost-effective, high-value intervention over a lifetime horizon. These robust health-economic findings conclusively justify initial neurosurgical expenditures, endorsing the broader and sustainable integration of DBS for advanced PD in Türkiye.