Department of Neurological Surgery, Boston University School of Medicine, Boston, MA
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.
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.
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%.
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.
Microelectrode Recording, Deep Brain Stimulation, ParkinsonŐs Disease, Operating Room, Subthalamic Nucleus, Neurosurgery
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.
1. Patel NK, Plaha P, O'Sullivan K, McCarter R, Heywood P, Gill SS. MRI directed bilateral stimulation of the subthalamic nucleus in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 2003;74(12):1631-7.
3. Pilitsis JG, Rezai AR, Boulis NM, Henderson JM, Busch RM, Kubu CS. A preliminary study of transient confusional states following bilateral subthalamic stimulation for Parkinson's disease. Stereotact Funct Neurosurg. 2005;83(2-3):67-70.
4. Goodman RR, Kim B, McClelland S 3rd, et al. Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson's disease. J Neurol Neurosurg Psychiatry. 2006;77(1):12-7.