OBJECTIVES: Deep brain stimulation (DBS) is the standard-of-care for medically-refractory essential tremor (ET) in the UK due to its established efficacy and reversibility. However, due to its invasive nature, DBS can cause potentially severe adverse events including infections and device-related complications. Magnetic resonance-guided focussed ultrasound (MRgFUS) is a minimally invasive technique explored recently in medically-refractory ET. This was a cost-consequence analysis (CCA) of MRgFUS vs. unilateral DBS in the UK setting.

METHODS: The CCA was developed from the National Health Service (NHS) England perspective. The base case considered a 13-month time horizon to capture changes in tremor symptoms and adverse events following an initial procedure and subsequent procedures due to complications. Outcomes reported were costs, tremor score changes, life years gained, and disutilities due to adverse events. Clinical data were obtained from published literature; cost data were primarily taken from the NHS 2016–2017 reference costs. Scenario analyses considered a 24-month time horizon and alternative assumptions around clinical outcomes. Deterministic and probabilistic sensitivity analyses were employed to identify key model drivers and assess uncertainty.

RESULTS: In the base case, MRgFUS resulted in total cost-savings of £9,772.47 per patient compared with DBS. The per patient costs for initial procedures, subsequent procedures due to adverse events (AEs), pre-procedure planning and follow-up were lower for MRgFUS than DBS by £9,086.90. Cost of AEs were lower for MRgFUS than DBS by £685.57. MRgFUS was also cost-saving in the scenario analyses. Clinical outcomes and disutilities were comparable between interventions in the base case and scenario analyses. Model results were most sensitive to MRgFUS and DBS procedure cost.

CONCLUSIONS: These results demonstrate that MRgFUS is a lower cost intervention compared with DBS in medically-refractory ET patients in the UK, and may inform treatment decisions for patients who prefer to avoid invasive surgeries or are ineligible for DBS.