Cost-minimisation model of magnetic resonance-guided focussed ultrasound therapy compared to unilateral deep brain stimulation for essential tremor treatment in Japan

PLoS One. 2019 Jul 17;14(7):e0219929. doi: 10.1371/journal.pone.0219929. eCollection 2019.


Objective: To investigate the cost differences between magnetic resonance-guided focussed ultrasound (MRgFUS) and unilateral deep brain stimulation (DBS) for the treatment of medication-refractory essential tremor (ET) in Japan using a cost-minimisation model.

Methods: A cost-minimisation model estimated total costs for MRgFUS and unilateral DBS by summing the pre-procedure, procedure, and post-procedure costs over a 12-month time horizon, using data from published sources and expert clinical opinion. The model base case considered medical costs from fee-for-service tariffs. Scenario analyses investigated the use of Diagnosis Procedure Combination tariffs, a diagnosis-related group-based fixed-payment system, and the addition of healthcare professional labour costs healthcare professionals using tariffs from the Japanese Health Insurance Federation for Surgery. One-way sensitivity analyses altered costs associated with tremor recurrence after MRgFUS, the extraction rate following unilateral DBS, the length of hospitalisation for unilateral DBS and the procedure duration for MRgFUS. The impact of uncertainty in model parameters on the model results was further explored using probabilistic sensitivity analysis.

Results: Compared to unilateral DBS, MRgFUS was cost saving in the base case and Diagnosis Procedure Combination cost scenario, with total savings of JPY400,380 and JPY414,691, respectively. The majority of savings were accrued at the procedural stage. Including labour costs further increased the cost differences between MRgFUS and unilateral DBS. Cost savings were maintained in each sensitivity analysis and the probabilistic sensitivity analysis, demonstrating that the model results are highly robust.

Conclusions: In the Japanese healthcare setting, MRgFUS could be a cost saving option versus unilateral DBS for treating medication-refractory ET. The model results may even be conservative, as the cost of multiple follow-ups for unilateral DBS and treatment costs for adverse events associated with each procedure were not included. This model is also consistent with the results of other economic analyses of MRgFUS versus DBS in various settings worldwide.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Deep Brain Stimulation* / economics
  • Deep Brain Stimulation* / methods
  • Essential Tremor / diagnostic imaging*
  • Essential Tremor / therapy*
  • Humans
  • Japan
  • Magnetic Resonance Imaging* / economics
  • Magnetic Resonance Imaging* / methods
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ultrasonic Therapy* / economics
  • Ultrasonic Therapy* / methods

Grants and funding

This work was wholly funded by INSIGHTEC Ltd. The authors are employees of the University of Tokyo, Japan; Tokyo Women’s Medical University, Japan; Kumamoto University, Japan; INSIGHTEC Ltd, Israel; and Costello Medical Consulting Ltd, UK. All authors were contracted by INSIGHTEC Ltd to perform this study and Costello Medical Consulting Ltd were further contracted for medical writing and editorial support. Lance Richard, an employee of INSIGHTEC Ltd (the funder of this study), was involved in the decision to publish this manuscript, manuscript preparation (original draft preparation only) and study design, but had no influence on the data collection and analysis involved in generating model results. Publication of the study results was not contingent on the sponsor’s approval or censorship of the manuscript.