Abstract
Background: Deep Brain Stimulation (DBS) has been used successfully for the treatment of advanced Parkinson's disease (PD) and is known to be effective in managing the motor symptoms of PD, as well as reducing reliance on anti-Parkinsonian medications. But its pharmacoeconomic effects are still poorly known in LAMIC countries. The purpose of this study was to assess medication utilization, direct medication cost reduction and adverse event profile in PD patients in Pakistan after DBS.
Methodology: A mixed retrospective–prospective observational pre–post study was performed in 50 Parkinson's disease (PD) patients who had undergone bilateral subthalamic nucleus (STN) DBS in a tertiary care center in Pakistan. Both pre-operative and post-operative data were retrieved from medical records and follow-up and telephonic interviews were used to gather the post-operative data. Medication use, direct medication expenses, and adverse events within six months of surgery were evaluated. Paired-sample tests were used to analyze data and a p value of < 0.05 was considered statistically significant.
Results: 88.0% (44/50) of patients had reduction in medication and 84.0% (42/50) of patients had reduction in direct medication costs. The expenditure of medicines after the surgery was significantly less than before the surgery (p<0.0001). Thirty-four percent (17/50) of patients reported adverse events, most of which were mild to moderate and short-lived. With the Naranjo Adverse Drug Reaction Probability Scale, 16.0% (8/50) of patients suffered from adverse drug reactions.
Finding: DBS was shown to be significantly associated with decreased medication use and direct medication expenditures and cost without any adverse impact on patient safety. The results are important and demonstrate the pharmacoeconomic benefit of DBS in lowering the chronic drug burden for PD patients in resource-constrained health care systems. Additional multi-center trials with QOL data and comprehensive economic evaluations are recommended