Deep Brain Stimulation: A Cost-Saving Treatment Option for Extreme Treatment-Refractory Obsessive-Compulsive Disorder in the UK?
Author(s)
Alex Mclean, MSc1, Alex Porteous, BA, MSc2, Sari Wright, BSc2, Eve McArthur, BSc2, Joshua Gahan, BSc2, Nicolas T Sireau, PhD3, Margherita Zenoni, BSc, MSc4, Naomi A Fineberg, MBBS, MA, MRCPsych5, Jose M Menchon, MD, PhD6, Himanshu Tyagi, PhD, FRCPsych7.
1Costello Medical, Bristol, United Kingdom, 2Costello Medical, London, United Kingdom, 3Orchard OCD, Cambridge, United Kingdom, 4University of Cambridge, Cambridge, United Kingdom, 5School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom, 6Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain, 7National Hospital for Neurology and Neurosurgery, London, United Kingdom.
1Costello Medical, Bristol, United Kingdom, 2Costello Medical, London, United Kingdom, 3Orchard OCD, Cambridge, United Kingdom, 4University of Cambridge, Cambridge, United Kingdom, 5School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom, 6Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain, 7National Hospital for Neurology and Neurosurgery, London, United Kingdom.
OBJECTIVES: Deep brain stimulation (DBS) is a neurosurgical procedure that has gained attention as a potential treatment for extreme treatment-refractory obsessive-compulsive disorder (TROCD), but is not recommended by NICE due to limited evidence within the UK setting. This research investigated the cost-offsets between maintenance treatments as usual and DBS for extreme TROCD.
METHODS: A cost-offset model (COM) was developed from an NHS and Personal Social Services perspective to determine the difference in direct costs for the use of DBS in combination with maintenance treatments, compared with maintenance treatments alone for patients with extreme TROCD over a lifetime time horizon (60 years). Costs were discounted at 3.5% per year. Inputs were sourced from the literature, national databases and clinical opinion, which was crucial due to limited efficacy data. Three DBS response states were modelled (full; partial; no response). Sensitivity and scenario analyses were performed.
RESULTS: Over the time horizon, DBS in combination with maintenance treatments (£282,469) resulted in substantial cost-savings (−£194,724) compared with maintenance treatments alone (£477,193). Cost-savings emerged after seven years, driven by reduced monitoring and healthcare resource use for those responding to DBS. The main DBS costs were surgery administration, device removal and device acquisition. For both treatment arms, the main costs of maintenance treatments were for inpatient stay. Deterministic sensitivity analysis showed that inputs with the greatest sensitivity were costs and frequencies of inpatient stay. Other influential inputs included the modelled discount rate and IPG replacement costs. One of the most influential scenarios was including the societal perspective, resulting in a +119.52% increase in cost-savings for DBS.
CONCLUSIONS: The COM demonstrates potential for DBS to result in considerable cost-savings for the healthcare payer and individual compared with standard of care for extreme TROCD patients, despite high upfront costs, if all efficacy benefits are validated through further research.
METHODS: A cost-offset model (COM) was developed from an NHS and Personal Social Services perspective to determine the difference in direct costs for the use of DBS in combination with maintenance treatments, compared with maintenance treatments alone for patients with extreme TROCD over a lifetime time horizon (60 years). Costs were discounted at 3.5% per year. Inputs were sourced from the literature, national databases and clinical opinion, which was crucial due to limited efficacy data. Three DBS response states were modelled (full; partial; no response). Sensitivity and scenario analyses were performed.
RESULTS: Over the time horizon, DBS in combination with maintenance treatments (£282,469) resulted in substantial cost-savings (−£194,724) compared with maintenance treatments alone (£477,193). Cost-savings emerged after seven years, driven by reduced monitoring and healthcare resource use for those responding to DBS. The main DBS costs were surgery administration, device removal and device acquisition. For both treatment arms, the main costs of maintenance treatments were for inpatient stay. Deterministic sensitivity analysis showed that inputs with the greatest sensitivity were costs and frequencies of inpatient stay. Other influential inputs included the modelled discount rate and IPG replacement costs. One of the most influential scenarios was including the societal perspective, resulting in a +119.52% increase in cost-savings for DBS.
CONCLUSIONS: The COM demonstrates potential for DBS to result in considerable cost-savings for the healthcare payer and individual compared with standard of care for extreme TROCD patients, despite high upfront costs, if all efficacy benefits are validated through further research.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE320
Topic
Economic Evaluation, Medical Technologies
Disease
Mental Health (including addition)