Authors' recommendations: There is evidence to indicate that DBS is an effective treatment for certain patients with treatment-refractory Parkinson‟s disease. Evidence for essential tremor and dystonia is weaker, but experts have concluded that DBS is an appropriate secondline therapy for patients with significant functional impairment that have failed to have an adequate response from conventional therapy. The HSE has funded DBS treatment for these indications since 1997, and so far over 130 patients have been treated. Approximately 13 new patients a year with Parkinson‟s disease, essential tremor and dystonia are referred for DBS treatment through the TAS. Given the epidemiology of the diseases and the experience of DBS services in the UK, this represents an under-supply of services in this area. If a national DBS service was established in Ireland, it is anticipated that the demand for DBS surgery for the specified movement disorders would increase from 13 to 19 patients per year. Results of an economic analysis comparing the current TAS service delivery model to a prospective national DBS service show that an Irish service will cost more per patient. Given the existing arrangements with regard to private health insurance, where a greater proportion of costs can be met by insurers under the TAS scheme, an Irish service would result in a 47% increase in per-patient costs. A budget impact analysis (BIA) was conducted using the current status-quo with regard to reimbursement by insurers and assuming that 32% of DBS patients hold private health insurance. This shows that an Irish service would cost an additional €1.84 million over the first five years of the service compared to the €4.29 million required to treat the same number of patients through the TAS. In a scenario analogous to a single payer system, where the entire cost of DBS care for an individual patient is entirely borne by one provider, the cost difference is reduced to approximately €4,000 per patient over 10 years. In sensitivity analyses, changes to the relative contribution by private health insurance companies to the cost of DBS care for patients with private health insurance substantially influenced the estimated five-year budget impact of the different service delivery models and could potentially render a national programme more affordable than in the base case analysis. A prospective national service that replaces the current TAS service delivery model would have implications for patients, the organisation of services and resource requirements. DBS is a long-term treatment for a chronic condition; demand for services is cumulative, with patients treated in preceding years requiring ongoing care in addition to the care required for new referrals. Adequate planning and resources would be required to ensure continuity or care is maintained, sufficient service capacity is available for existing patients, levels of access to DBS treatment are maintained for new referrals and that the development of a national DBS service does not negatively impact access of other patients to existing neurosurgical services. A new service would also need to meet appropriate quality standards to ensure that a consistently high quality of care is provided, as well as developing the skills, experience and capacity to meet the demand for DBS.

Project Status: Completed

URL for project: http://www.hiqa.ie/press-release/2012-01-27-deep-brain-stimulation-service-be-assessed-hiqa

Year Published: 2012

URL for published report: http://www.hiqa.ie/publications/health-technology-assessment-national-deep-brain-stimulation-service-ireland

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Ireland

Organisation Name: Health Information and Quality Authority (HIQA)

Contact Address: Health Information and Quality Authority, George's Court, George's Lane,Smithfield, Dublin 7. PH : + 353 (01) 814 7464

Contact Name: info@hiqa.ie

Contact Email: info@hiqa.ie

Copyright: Health Information and Quality Authority