Deep brain stimulation for Parkinson's disease in Thailand: cost, utility and policy implications for universal health coverage.

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.