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

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. 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. 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. 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.

Déclaration de conflit d'intérêts

Ataru Igarashi – received financial support for this work through research grants from INSIGHTEC Ltd, Israel. Has also received research grants outside this research from Pfizer Japan Inc; Intuitive Surgical Inc; Taiho Yakuhin Inc; Boston Scientific Inc; SONY Inc; Incitec Japan Inc; Milliman Inc; Gilead Sciences KK; Terumo Inc; Fuji Film Inc; Omnica Co, Ltd and CSL Boering Inc. Received compensation for invited lectures and served as an advisor for Novartis Pharma Japan Inc; Pfizer Japan Inc; Sanofi Japan Inc; Novo Nordisk Japan Inc; Abbvie GK and Ono Pharma Inc. Midori Tanaka – none. Keiichi Abe – none. Lance Richard – employee of INSIGHTEC Ltd (the funder of this study); involved in the decision to publish this manuscript, preparation of this manuscript (original draft preparation only) and study design, but had no influence on the data collection and analysis involved in generating model results. Vivian Peirce – employee of Costello Medical Consulting Ltd; involved in data analysis and preparation of the manuscript (original draft preparation and review & editing), but had no influence on the study design, data collection or the decision to publish. Kazumichi Yamada – none. Individuals mentioned in acknowledgements (not authors) Molly Atkinson – employee of Costello Medical Consulting Ltd; provided medical writing assistance and editorial assistance in preparing the manuscript for publication, based on the authors’ input and direction. Natalie Hearmon – employee of Costello Medical Consulting Ltd; provided model programming assistance in response to changes requested by the peer reviewers. Overall, the competing interests as specified above do not alter our adherence to PLOS One policies on sharing data and materials. Furthermore, the above competing interest statement provides a complete and specific description of the involvement of INSIGHTEC Ltd and Costello Medical Consulting Ltd, as no other individuals from either company were involved in the study design, data collection and analysis, decision to publish or preparation of the manuscript.