The cost-effectiveness of deep brain stimulation for patients with treatment-resistant obsessive-compulsive disorder


Abstract

Background: Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder with a 2% to 3% lifetime prevalence; in addition, 10% of OCD patients are resistant to conventional therapy. Deep brain stimulation (DBS) has been an effective treatment for treatment resistant OCD patients (TROCD). We aimed to determine the cost-effectiveness of DBS for TROCD.

Methods: We used a Markov model to estimate the cost-effectiveness of DBS compared to conventional treatment for TROCD with a 10-year time horizon. Published data were used to estimate the rates of treatment response and complications. Costs were calculated from the perspective of the third-party payer. Data on quality of life were obtained from a literature review and a survey of OCD patients. We applied the model separately to Korea and the United Kingdom (UK) to enhance the validity.

Results: Base-case analysis showed an incremental cost-effectiveness ratio of US$37,865 per quality-adjusted life-year in Korea and US$34,462 per quality-adjusted life-year in the UK. According to the World Health Organization''s criteria, DBS for TROCD was "cost-effective" in Korea (<3x GDP per capita) and "highly cost-effective" in the UK (<GDP per capita). One-way sensitivity analysis showed consistent cost-effectiveness results for most variables with the exception of short-term duration of treatment effect (<4 years in Korea; <3 years in the UK).

Conclusion: The results showed that DBS is a cost-effective treatment for TROCD in both the countries. Our findings provide economic evidence on the applicability of DBS for patients, health care service providers, and payers.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Structure of the Markov model. According to the presence of a treatment effect and/or complications after DBS, TROCD patients are classified into 1 of 5 statuses after DBS treatment: response with complication, response without complication, no response with complication, TROCD (no response without complication), and death. Patients who continue conventional OCD treatment (CBT and pharmacotherapy) are assumed to remain in TROCD status. CBT?=?cognitive behavioral therapy, DBS?=?deep brain stimulation, OCD?=?obsessive-compulsive disorder, TROCD?=?treatment-resistant obsessive-compulsive disorder.
Figure 2
Figure 2
Univariate sensitivity analysis for duration of DBS treatment effect (Korea). DBS?=?deep brain stimulation, ICER?=?incremental cost-effectiveness ratio, QALY?=?quality-adjusted life-year.
Figure 3
Figure 3
Univariate sensitivity analysis for duration of DBS treatment effect (UK). DBS?=?deep brain stimulation, ICER?=?incremental cost-effectiveness ratio, QALY?=?quality-adjusted life-year.
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