Medical device company (Major).
How do we secure reimbursement for deep brain stimulation (DBS) for advanced Parkinson’s Disease, following closure of recruitment to an RCT, but with results pending completion of follow up?
Whilst DBS was already recommended in European clinical guidelines (Level B evidence) as an option for the treatment of motor fluctuations in advanced PD, hospitals were unable to offer the procedure without the means to have costs reimbursed.
We reviewed published literature to identify data points for calculations, which were then built into a procedure cost calculator and budget impact model. We considered procedure and drug costs, along with the cost of extended stays and readmissions for complications. Budget impact was then calculated from the perspective of a UK payor. Using the combined results, we created an evidence based option appraisal and investment case for national reimbursement.
The model estimated that, over the lifetime of the patient, the DBS pathway would cost, on average, 46% less than the conventional “drugs only” pathway.
Whilst DBS surgery resulted in increased costs during the first year of treatment, due to a reduction in dependence on drugs for symptom control and their associated disabling side effects, a 23% reduction in total treatment costs was projected for subsequent years.
Taking into account the backlog of patients eligible for treatment, the model predicted that payors would break even by year 6, after which significant savings could be made across the healthcare system.
As a consequence, a tariff and national reimbursement pathway for DBS was established. Real world evidence can guide reimbursement decisions, improving patient access to technology enabled and life enhancing treatments.
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