Authors' objectives: This health technology assessment evaluates the effectiveness and safety of magnetic resonance-guided focused ultrasound (MRgFUS) neurosurgery for people with treatment-refractory obsessive–compulsive disorder (OCD). It also evaluates the budget impact of publicly funding MRgFUS neurosurgery and the experiences, preferences, and values of people with treatment-refractory OCD.

Authors' results and conclusions: RESULTS We included 2 studies in the clinical evidence review. In these small case series, MRgFUS neurosurgery led to improvements in OCD symptoms, quality of life, and patient functioning, as well as treatment response for many but not all patients (GRADE: Very low). In a minority of cases, the procedure could not be successfully performed due to skull factors (GRADE: Very low). MRgFUS neurosurgery was also found to have a favourable safety profile (GRADE: Very low). No cases of re-treatment were reported (GRADE: Very low). No studies compared MRgFUS neurosurgery with other neurosurgeries. Due to the lack of comparative clinical evidence, the cost-effectiveness of MRgFUS neurosurgery could not be determined. Our budget impact analysis found that publicly funding MRgFUS neurosurgery for people with treatment-refractory OCD in Ontario would cost an additional $1.9 million over 5 years. Patients reported the negative impacts that OCD had on their day-to-day activities, work and school, social life and family relationships, and mental health. The 6 participants who underwent MRgFUS neurosurgery commented on the positive impact that it had on their OCD symptoms, mental health, and quality of life. CONCLUSIONS MRgFUS neurosurgery may be an effective and generally safe treatment option for severe, treatment-refractory OCD, but the evidence is very uncertain. The cost-effectiveness of MRgFUS neurosurgery could not be determined given the lack of comparative clinical evidence. Publicly funding MRgFUS neurosurgery for people with treatment-refractory OCD in Ontario would result in an additional cost of $1.9 million over 5 years. Patients and care partners emphasized the negative impact of OCD in their lives and highlighted the importance of having access to MRgFUS neurosurgery as a treatment option for treatment-refractory OCD.

Authors' recommendations: Ontario Health, based on guidance from the Ontario Health Technology Advisory Committee, recommends time-limited public funding for magnetic resonance-guided focused ultrasound (MRgFUS) neurosurgery for people with treatment-refractory obsessive–compulsive disorder (OCD), during which time further data will be collected.

Authors' methods: We performed a systematic literature search of the clinical evidence published since 2013. We assessed the risk of bias of each included study using the Joanna Briggs Institute's Critical Appraisal Checklist for Case Series, and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic literature search of the economic evidence. We estimated the 5-year budget impact of publicly funding MRgFUS neurosurgery for people with treatment-refractory OCD in Ontario. Owing to a lack of comparative clinical evidence, we did not conduct a primary economic evaluation. To contextualize the value of MRgFUS neurosurgery, we spoke to people with treatment-refractory OCD who underwent the procedure, as well as those on the waitlist.

Project Status: Completed

URL for project: https://ontariohealth.ca/system/health-innovation-pathway/reviews/hta-details?cf=magnetic-resonance-ultrasound-neurosurgery-ocd

URL for protocol: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023457743

Year Published: 2025

URL for published report: https://pmc.ncbi.nlm.nih.gov/articles/PMC12148002/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Ontario

Pubmed ID: 40496675

Organisation Name: Ontario Health

Contact Address: 525 University Ave, Toronto, ON M5G 2L3

Contact Name: HealthInnovationPathway@ontariohealth.ca

Contact Email: HealthInnovationPathway@ontariohealth.ca

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