Department of Neurological Surgery, Boston University
School of Medicine, Boston, MA
Introduction:
Deep brain stimulation (DBS) of the subthalamic
nucleus (STN) is the standard of care for treating medically intractable
ParkinsonŐs Disease (PD). Multiple
studies have demonstrated that the adjunct of microelectrode recording (MER)
improves the targeting accuracy of STN DBS in comparison with image-guidance
alone. However, there has been no
investigation as to the financial cost of intraoperative MER. This study was performed to address
this issue.
Methods:
A comprehensive literature search was performed of large
STN DBS series (minimum 75 patients), revealing a mean operating room (OR) time
of 223.83 minutes for unilateral and 279.79 minutes for simultaneous bilateral
implantation. The baseline
OR time was derived from the published OR time for STN DBS without MER. The total cost (OR, anesthesia,
neurosurgery) was then calculated based on hospitals geographically
representative of the entire United States.
Results:
The average cost for STN DBS implantation with
MER per patient is $26,764.79
for unilateral, $33,481.43 for
simultaneous bilateral, and $53,529.58 for
staged bilateral. For unilateral
implantation, the cost of MER is $19461.75,
increasing total cost by 267%. For simultaneous bilateral, MER costs $20535.98, increasing total cost
by 159%. For staged bilateral, MER costs $38923.49 and increases total
cost by 267%.
Conclusion:
MER more than doubles the cost of STN DBS for PD,
and more than triples the cost for unilateral and staged bilateral procedures.
The cost burden of MER to STN DBS requires the clinical efficacy of MER to be
proven in a prospective evidence-based manner in order to curtail the potential
for excessive financial burden to the healthcare system.
Keywords:
Microelectrode
Recording, Deep Brain Stimulation, ParkinsonŐs Disease, Operating Room,
Subthalamic Nucleus, Neurosurgery
Objectives:
1.
Understand the role that microelectrode recording (MER) presently plays
in subthalamic nucleus (STN) deep brain stimulation (DBS).
2.
Know the estimated operating room time for STN DBS with MER according
to the published literature.
3.
Be familiar with the impact of MER on patient cost in STN DBS.
References:
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Plaha P,
O'Sullivan K,
McCarter R,
Heywood P,
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MRI directed bilateral stimulation of the subthalamic nucleus in patients with
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Wilkinson SB,
Overman J,
Pahwa R.
Surgical and hardware complications of subthalamic stimulation: a series of 160
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Goodman RR,
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3rd, et al. Operative
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