Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor

Mov Disord. 2017 Aug;32(8):1165-1173. doi: 10.1002/mds.26997. Epub 2017 Apr 3.


Background: Essential tremor remains a very common yet medically refractory condition. A recent phase 3 study demonstrated that magnetic resonance-guided focused ultrasound thalamotomy significantly improved upper limb tremor. The objectives of this study were to assess this novel therapy's cost-effectiveness compared with existing procedural options.

Methods: Literature searches of magnetic resonance-guided focused ultrasound thalamotomy, DBS, and stereotactic radiosurgery for essential tremor were performed. Pre- and postoperative tremor-related disability scores were collected from 32 studies involving 83 magnetic resonance-guided focused ultrasound thalamotomies, 615 DBSs, and 260 stereotactic radiosurgery cases. Utility, defined as quality of life and derived from percent change in functional disability, was calculated; Medicare reimbursement was employed as a proxy for societal cost. Medicare reimbursement rates are not established for magnetic resonance-guided focused ultrasound thalamotomy for essential tremor; therefore, reimbursements were estimated to be approximately equivalent to stereotactic radiosurgery to assess a cost threshold. A decision analysis model was constructed to examine the most cost-effective option for essential tremor, implementing meta-analytic techniques.

Results: Magnetic resonance-guided focused ultrasound thalamotomy resulted in significantly higher utility scores compared with DBS (P < 0.001) or stereotactic radiosurgery (P < 0.001). Projected costs of magnetic resonance-guided focused ultrasound thalamotomy were significantly less than DBS (P < 0.001), but not significantly different from radiosurgery.

Conclusions: Magnetic resonance-guided focused ultrasound thalamotomy is cost-effective for tremor compared with DBS and stereotactic radiosurgery and more effective than both. Even if longer follow-up finds changes in effectiveness or costs, focused ultrasound thalamotomy will likely remain competitive with both alternatives. © 2017 International Parkinson and Movement Disorder Society.

Keywords: cost-effectiveness; deep brain stimulation; essential tremor; focused ultrasound; radiosurgery.

MeSH terms

  • Aged
  • Clinical Trials as Topic / statistics & numerical data
  • Cost-Benefit Analysis
  • Databases, Bibliographic / statistics & numerical data
  • Deep Brain Stimulation / economics
  • Deep Brain Stimulation / methods*
  • Essential Tremor* / diagnostic imaging
  • Essential Tremor* / economics
  • Essential Tremor* / therapy
  • Female
  • Humans
  • Magnetic Resonance Imaging / economics
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Radiosurgery / economics
  • Radiosurgery / methods*
  • Retrospective Studies
  • Ultrasonography / economics
  • Ultrasonography / methods*