BMJ neurology open · 2026
Deep brain stimulation for Parkinson's disease in Thailand: cost, utility and policy implications for universal health coverage.
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Aungsumart Saharat, Songpattanasilp Atittan, Rujirussawarawong Surachet, Ounmuang Chawarat, Sathirapanya Praewchompoo, Limotai Natlada
Аннотация
BACKGROUND: Parkinson's disease (PD) is a chronic, progressive, disabling neurodegenerative disorder. Deep brain stimulation (DBS) surgery is a highly effective and beneficial therapy for advanced PD, but its substantial cost limits accessibility. This study aimed to evaluate the cost-utility and budget impact of rechargeable and non-rechargeable DBS compared with standard pharmacotherapy alone in patients with advanced PD.
METHODS: We conducted a cost-utility analysis using a Markov model with a 6-month cycle length and a 20-year time horizon. Costs were valued in 2025 Thai Baht, and both costs and outcomes were discounted at 3% per year. The model consisted of six health states based on the Modified Hoehn & Yahr scale. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained. Secondary outcomes included total costs, life-years, QALYs and a 5-year budget impact from the government perspective. Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty.
RESULTS: Medication alone produced 5.80 QALYs, compared with 7.38 QALYs for both rechargeable and non-rechargeable DBS, yielding 1.57 incremental QALYs. Rechargeable DBS resulted in an incremental cost of THB506 720 (US$15 678), corresponding to an ICER of THB321 940 (US$9958) per QALY. While non-rechargeable DBS resulted in an incremental cost of THB639 454 (US$19 785), corresponding to an ICER of THB406 272 (US$12 567) per QALY. Probabilistic analysis produced similar values (ICERs of THB293 354-THB350 761 per QALY). All ICERs exceeded Thailand's willingness-to-pay threshold of THB160 000 (US$4950) per QALY. The projected 5-year budget impact was THB60.9-THB69.0 million (US$1.9-US$2.1 million) per year.
CONCLUSIONS: DBS for patients with advanced PD is not currently cost-effective within Thailand's national healthcare system. Supported by the actionable evidence in this study, strategic pricing and policy changes will enable equitable access to therapy.
METHODS: We conducted a cost-utility analysis using a Markov model with a 6-month cycle length and a 20-year time horizon. Costs were valued in 2025 Thai Baht, and both costs and outcomes were discounted at 3% per year. The model consisted of six health states based on the Modified Hoehn & Yahr scale. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained. Secondary outcomes included total costs, life-years, QALYs and a 5-year budget impact from the government perspective. Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty.
RESULTS: Medication alone produced 5.80 QALYs, compared with 7.38 QALYs for both rechargeable and non-rechargeable DBS, yielding 1.57 incremental QALYs. Rechargeable DBS resulted in an incremental cost of THB506 720 (US$15 678), corresponding to an ICER of THB321 940 (US$9958) per QALY. While non-rechargeable DBS resulted in an incremental cost of THB639 454 (US$19 785), corresponding to an ICER of THB406 272 (US$12 567) per QALY. Probabilistic analysis produced similar values (ICERs of THB293 354-THB350 761 per QALY). All ICERs exceeded Thailand's willingness-to-pay threshold of THB160 000 (US$4950) per QALY. The projected 5-year budget impact was THB60.9-THB69.0 million (US$1.9-US$2.1 million) per year.
CONCLUSIONS: DBS for patients with advanced PD is not currently cost-effective within Thailand's national healthcare system. Supported by the actionable evidence in this study, strategic pricing and policy changes will enable equitable access to therapy.