The cost-effectiveness of Magnetic Resonance-Guided Focused Ultrasound compared to Deep Brain Stimulation for the treatment of essential tremor

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.

The paper reporting this work is published in the British Journal of Radiology. The full text can be accessed here.

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

References

1.           Essential Tremor NEW [Internet]. Tremor | The National Tremor Foundation. [cited 2021 Oct 4]. Available from: https://tremor.org.uk/essential-tremor

2.           Louis ED, Barnes L, Albert SM, Cote L, Schneier FR, Pullman SL, et al. Correlates of functional disability in essential tremor. Mov Disord Off J Mov Disord Soc. 2001 Sep;16(5):914–20.

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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