The Health Information and Quality Authority has published the results of a health technology assessment (HTA) of a national deep brain stimulation (DBS) programme for adults with movement disorders.

Dr Mairin Ryan, Director of Health Technology Assessment in HIQA, said “since 1997 over 130 Irish patients have received DBS treatment abroad, funded through the E112 Treatment Abroad Scheme. This HTA shows that, for equal numbers of patients treated, the current system where patients are routinely referred to the UK for treatment costs less than a proposed service provided nationally. However, an adequately resourced Irish service would have benefits, both for the overall numbers of patients who can avail of the treatment, as well as for individual patients receiving long-term DBS care”.

DBS is a surgical approach to treating the symptoms of advanced Parkinson’s disease, dystonia and essential tremor that cannot be adequately controlled using medication alone. As there is currently no DBS programme within the Irish healthcare system, patients are routinely referred to centres in the UK for treatment, with funding provided under the E112 Treatment Abroad Scheme (TAS).

At present, patients who are able to travel have timely access to high-quality care in established UK DBS centres. The benefits of a national DBS service would include improving access to care for eligible patients who are unable to travel overseas. It would also reduce the significant financial and logistical burden on patients who do travel to access care and would facilitate greater integration of services, since all stages of the assessment, surgery and follow-up care could be carried out in Ireland. Access to emergency care in cases of adverse effects or complications would also be improved, as the need to obtain TAS approval and arrange overseas travel at short notice would be removed.

“These benefits could only be realised if an Irish programme was established in accordance with international standards for high quality DBS services, with the resources, expertise and support services needed to meet the anticipated level of demand,” Dr Ryan said.

The Authority’s assessment found that the cost of a national DBS programme in Ireland would exceed the cost of continuing to fund DBS through the Treatment Abroad Scheme by approximately €21,000 per patient over 10 years. Over five years, the total cost of a national DBS programme is estimated at €1.84 million more than the €4.29 million required to treat the same number of patients through the TAS. This cost difference will, however, be significantly impacted by any changes to health insurance arrangements.

“A new national DBS programme would place extra demands on existing resources (e.g. operating theatre time, neurosurgical bed days, consultant appointments); requiring appropriate service planning prior to its introduction to ensure that existing neurological services are not affected or that patient access to DBS surgery is not curtailed by the establishment of a national DBS centre. This is particularly relevant given the significant capacity constraints that have already been identified in Irish neurosurgical services,” Dr Ryan said.

The Board of the Authority has approved the HTA report and it has been submitted to the HSE for consideration. For a full copy of the report go to www.hiqa.ie. You can also find us on Facebook and Twitter by searching ‘HIQA’.

ENDS.

Further Information: 

Sinead Whooley, Communications Manager, Health Information and Quality Authority, Tel: 01 814 7488/ 087 922 1941 Email: swhooley@hiqa.ie

Notes to the Editor: 

• HIQA is the statutory organisation in Ireland with a responsibility to carry out national health technology assessments (HTAs) and to develop guidelines for the conduct of HTAs across our healthcare system.
• Deep brain stimulation (DBS) is used to treat the symptoms of a number of movement disorders, such as Parkinson’s disease, dystonia and essential tremor that cannot be adequately controlled using medication alone. It involves the implantation of electrodes in the brain that deliver electrical stimulation to targeted areas in the brain. Stimulation aims to interrupt faulty communication between the brain and the muscles that result in involuntary muscle movements; however, the exact mechanism of action of DBS is uncertain. The technology may enable patients suffering from various movement disorders to have greater control over their symptoms resulting in an improved quality of life. DBS does not cure the underlying condition and its effects are reversible.
• At present, approximately 13 new Irish patients undergo DBS surgery abroad annually, funded through the E112 Treatment Abroad Scheme. Based on the experience of DBS centres in the UK, a well-established national service would eventually expect to treat 19 new patients with movement disorders in Ireland annually.
• The economic analysis carried out in this HTA examined the comparative costs of the two DBS service delivery models: a prospective DBS service based in Ireland and the existing service where access to DBS care overseas is funded through the E112 Treatment Abroad Scheme. As the perspective taken was that of the publicly funded health and social care system, costs to the patient associated with accessing the treatment were excluded.
• There are existing capacity constraints in the publicly-funded neurological and neurosurgical services. As of May 2012, there were 532 patients awaiting neurosurgical procedures in Ireland, almost 40% of whom were waiting more than six months.