Aquarius Population Health

Medically refractory Essential Tremor (mrET) is the most common movement disorder affecting approximately 1 million in the United Kingdom and can be disabling. Medical treatment is not always successful at controlling tremors. Deep Brain Stimulation (DBS) is a proven neurosurgical treatment; however, the risks of surgery and anaesthesia mean some patients are ineligible for DBS. Magnetic Resonance Guided Focused Ultrasound (MRgFUS) is an emerging non-invasive technique that has been proven to be a safe and clinically effective mrET.

Aquarius partnered with Imperial College to model the cost-effectiveness of the MRgFUS treatment. Our study, recently published in the British Journal of Radiology,  demonstrates the favourable cost-effectiveness profile of MRgFUS treatment for mrET in England. The introduction of MRgFUS as a widely available ET treatment in the UK is currently undergoing regulatory approval. As this is the first European study, these favourable cost-effectiveness outcomes provide a basis for future commissioning of brain MRgFUS treatments in the UK, Europe and globally.

A Markov model was used to assess two sub-populations of mrET, those eligible and those ineligible for neurosurgery, in a context specific to England’s healthcare system. The model calculated the Incremental Cost-Effectiveness Ratio (ICER) with appropriate sensitivity and scenario analyses. The results demonstrate the favourable cost-effectiveness profile of MRgFUS treatment for mrET in England in both sub-populations.

For those eligible for neurosurgery, MRgFUS was compared to DBS, the current standard treatment. In the model base case, MRgFUS was economically dominant compared to DBS. MRgFUS was less costly and more effective generating 0.03 additional QALYs per patient over the 5-year time horizon.

For patients ineligible for neurosurgery, MRgFUS was compared to treatment with medication alone. In the model base case, MRgFUS cost over £16,000 more than medication alone but yielded 0.77 additional QALYs per patient, producing an ICER of £20,851 per QALY gained. This ICER falls within the National Institute of Clinical Excellence (NICE) willingness to pay threshold (WTP) of £20,000-30,000 per QALY

Jameel A, Meiwald A, Bain P, et al. The Cost-Effectiveness of unilateral magnetic Resonance-Guided focused ultrasound in comparison to unilateral deep brain stimulation for the treatment of medically refractory essential tremor in England. BJR. 2022 Sep 20; 20220137. Available from:

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