Essential Tremor (ET) is the most common movement disorder affecting approximately 1 million in the United Kingdom and causing considerable societal impact (1). Medical treatment has mixed efficacy with approximately 25%-55% response to treatment (2). Deep Brain Stimulation (DBS) is a proven neurosurgical treatment. However, the risks of surgery and anaesthesia mean some patients are ineligible.
Magnetic Resonance Guided Focused Ultrasound (MRgFUS) is an emerging non-invasive technique to treat tremor (3). MRgFUS causes tremor suppression by thermal ablation of tremor-sensitive brain tissue without general anaesthesia. Several international clinical trials have demonstrated MRgFUS a safe and clinically effective mrET treatment (4–6). This study aims to ascertain the cost-effectiveness of MRgFUS for the treatment of medically refractory Essential Tremor (mrET) in England.
A Markov model was used to assess two sub-populations of mrET, those eligible and those ineligible for neurosurgery, in the context of England’s healthcare system. MRgFUS treatment for mrET in England was found to have a favourable cost-effectiveness profile for both groups of ET patients.
The introduction of MRgFUS as a widely available ET treatment in the UK is currently undergoing the necessary stages of regulatory approval. As this is the first European study, these favourable cost-effectiveness outcomes (notably the model base case ICER falling within NICE’s WTP) can provide a basis for future commissioning of brain MRgFUS treatments in the UK, Europe and globally.
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 [Internet]. 2022 Sep 20 [cited 2022 Sep 27];20220137. Available from: https://doi.org/10.1259/bjr.20220137
1. Essential Tremor NEW [Internet]. Tremor | The National Tremor Foundation. [cited 2021 Oct 4]. Available from: https://tremor.org.uk/essential-tremor
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3. Meng Y, Hynynen K, Lipsman N. Applications of focused ultrasound in the brain: from thermoablation to drug delivery. Nat Rev Neurol. 2021 Jan;17(1):7–22.
4. Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, et al. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med. 2016 Aug 25;375(8):730–9.
5. Halpern CH, Santini V, Lipsman N, Lozano AM, Schwartz ML, Shah BB, et al. Three-year follow-up of prospective trial of focused ultrasound thalamotomy for essential tremor. Neurology. 2019 Dec 10;93(24):e2284–93.
6. Jameel A, Gedroyc W, Nandi D, Jones B, Kirmi O, Molloy S, et al. Two year data from a preliminary study of double lesion site MRgFUS treatment of Essential Tremor targeting the thalamus and the posterior subthalamic area. MedRxiv Prepr. 2021 Jan 2;2020.12.27.20248723.
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