HIỆU QUẢ ĐIỀU TRỊ VÀ KINH TẾ Y TẾ CỦA PHẪU THUẬT KÍCH THÍCH NÃO SÂU Ở BỆNH NHÂN PARKINSON TẠI VIỆT NAM

Abstract

Background: Deep brain stimulation (DBS) has been shown to be clinically effective and cost – effective in the treatment of advanced Parkinson’s disease (APD). However, this effectiveness in Vietnamese advanced Parkinson's patients haven’t been known. Methods: This was a prospective cohort study. The DBS-APD group and the best medical therapy (BMT)-APD group candidating for DBS were selected. All participants were evaluated MDS-UPDRS OFF-DBS/OFF-Med and ON-DBS/OFF-Med in DBS-APD group and OFF-Med in BMT-APD group, QoL Questionnaire of EQ-5D-5L, levodopa equivalent dose (LED) and costs of treaments (surgical complication, battery replacement, follow-up visits, allied health care, medications, and indirect costs). The health benefits were subsequently measured in QALYs (quality-adjusted life years) or in points of clinical indices. All data were recorded at baseline, 3-month and 6-month visit. Generalized Estimating Equation (GEE) was used to estimate effectiveness between two therapies. Results: A total of 73 participants were included with 36 for DBS-APD group and 37 for BMT-APD group.  Average age at study time was 63.1 ± 9.6 in DBS-APD group versus 58.2 ± 8.7 in BMT-APD group (p=.027). The duration of disease was 14.0 ± 5.2 years in DBS-APD group versus 9.7 ± 5,4 years in BMT-APD group (p=.001). In clinically effective analysis, MDS-UPDRS-III was 42.2 ± 14.2 in DBS-APD group with ON-DBS and OFF-Medication versus 64.6 ± 18.2 in DBS-APD group with OFF-DBS and OFF-Medication (p,<0.001) and versus 41.4 ± 11.0 in BMT-APD group with OFF-Medication (p=.785). LED reduced significantly in DBS-APD group versus BMT-APD group (514.6 ± 322.7 vs 1218.9 ± 402.3, p<0.01). In cost-effectiveness analysis, compare to BMT-APD group,  DBS-APD group was more cost-effective in correlation with MDS-UPDRS-IV with the sequential incremental utility 1.45, 1.47, 1.56 points at each 3-month visit (p<0.05). Conclusions: DBS improved significantly in motor symptoms and DBS could be cost-effective in Vietnamese advanced PD.