Objective: 1) To estimate deep brain stimulation (DBS) material costs for a 6-year-period at our institution considering two scenarios: a conservative one focused on gradual increase of new rechargeable devices; another one with a greater initial investment in rechargeable devices (both new cases and replacements); 2) to compare these estimates to costs of the preceding three years (2014-2016), when devices had higher prices and were mostly non-rechargeable.

Background: Albeit DBS has been shown to be cost-effective, it represents a costly burden for national health systems. This situation has been aggravated by the financial crisis and the reduced longevity of newer non-rechargeable batteries, which has led to a rise of battery replacements costs and complications (i.e., device infections), compromising the sustainability of DBS programs. We hypothesized that investing on rechargeable devices in the short term would result in a reduction of replacements and, hence, of total DBS costs in the middle-to-long term.

Methods: Descriptive analysis of the activity and material costs of DBS at our institution in 2014-2016; estimation of DBS material costs in 2017-2022 based on the aforementioned scenarios; calculation of the shortfall vs. saving resulting from comparison of the different DBS cost estimates to the costs from the 2014-2016 period.

Results: During the 2014-2016 period, the total DBS cost rose from 654.958,14€ in 2014 to 1.023.689,64€ in 2016 (56,30% increase). Regarding the estimates for the 2017-2022 period, the first scenario would benefit initially from devices price-cuts dropping to 907.665,00€ in 2017 (-11,30% compared to 2016, yet +38.58% relative to 2014), but would eventually resume the upwards trend, ending up in 2022 with a total DBS cost of 1.058.541,00€ (+3,40% vs. 2016; +61,62% vs. 2014). Conversely, the second scenario, in spite of greater cost-increase the first 3 years, would eventually lead to a reduction of replacements and subsequently of total DBS costs down to 775.676,00€ in 2022 (-24,03% relative to 2016; only +18,43% compared to 2014).

Conclusions: The cost and saving estimates of increasing rechargeable DBS devices (both new cases and replacements) support the notion that this strategy, while costly in the short term, could aid to ensure the sustainability of DBS programs in the long run.

References: [1] Eggington S, Valldeoriola F, Chaudhuri KR, et al. The cost-effectiveness of deep brain stimulation in combination with best medical therapy, versus best medical therapy alone, in advanced Parkinson’s disease. J Neurol 2014; 261: 106-16. [2] Pepper J, Zrinzo L, Mirza B, et al. The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure. Stereotact Funct Neurosurg 2013; 91: 56-65.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/estimates-of-cost-and-saving-effects-of-increasing-rechargeable-devices-on-the-sustainability-of-a-deep-brain-stimulation-program/