{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T04:45:26Z","timestamp":1789879526189,"version":"4.0.1"},"reference-count":57,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,4,3]],"date-time":"2017-04-03T00:00:00Z","timestamp":1491177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Essential tremor remains a very common yet medically refractory condition. A recent phase 3 study demonstrated that magnetic resonance\u2010guided focused ultrasound thalamotomy significantly improved upper limb tremor. The objectives of this study were to assess this novel therapy's cost\u2010effectiveness compared with existing procedural options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Literature searches of magnetic resonance\u2010guided focused ultrasound thalamotomy, DBS, and stereotactic radiosurgery for essential tremor were performed. Pre\u2010 and postoperative tremor\u2010related disability scores were collected from 32 studies involving 83 magnetic resonance\u2010guided focused ultrasound thalamotomies, 615 DBSs, and 260 stereotactic radiosurgery cases. Utility, defined as quality of life and derived from percent change in functional disability, was calculated; Medicare reimbursement was employed as a proxy for societal cost. Medicare reimbursement rates are not established for magnetic resonance\u2010guided focused ultrasound thalamotomy for essential tremor; therefore, reimbursements were estimated to be approximately equivalent to stereotactic radiosurgery to assess a cost threshold. A decision analysis model was constructed to examine the most cost\u2010effective option for essential tremor, implementing meta\u2010analytic techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Magnetic resonance\u2010guided focused ultrasound thalamotomy resulted in significantly higher utility scores compared with DBS (\n                      <jats:italic>P &lt;<\/jats:italic>\n                      0.001) or stereotactic radiosurgery (\n                      <jats:italic>P &lt;<\/jats:italic>\n                      0.001). Projected costs of magnetic resonance\u2010guided focused ultrasound thalamotomy were significantly less than DBS (\n                      <jats:italic>P &lt;<\/jats:italic>\n                      0.001), but not significantly different from radiosurgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Magnetic resonance\u2010guided focused ultrasound thalamotomy is cost\u2010effective for tremor compared with DBS and stereotactic radiosurgery and more effective than both. Even if longer follow\u2010up finds changes in effectiveness or costs, focused ultrasound thalamotomy will likely remain competitive with both alternatives. \u00a9 2017 International Parkinson and Movement Disorder Society<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mds.26997","type":"journal-article","created":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T07:18:00Z","timestamp":1491376680000},"page":"1165-1173","source":"Crossref","is-referenced-by-count":97,"title":["Cost\u2010effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor"],"prefix":"10.1002","volume":"32","author":[{"given":"Vinod K.","family":"Ravikumar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon J.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Traci S.","family":"Hornbeck","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica E.","family":"Santini","sequence":"additional","affiliation":[{"name":"Department of Neurology Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim Butts","family":"Pauly","sequence":"additional","affiliation":[{"name":"Department of Radiology Stanford University Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Wintermark","sequence":"additional","affiliation":[{"name":"Department of Radiology Stanford University Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pejman","family":"Ghanouni","sequence":"additional","affiliation":[{"name":"Department of Radiology Stanford University Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherman C.","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey H.","family":"Halpern","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2014.09.004"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870130117"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-304943"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-016-0627-8"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2006.03.001"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.4.1063"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22059"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8257(200101)16:1<140::AID-MDS1025>3.0.CO;2-T"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnur.2015.07.014"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2016.01.041"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26625"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.10.JNS141610"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3171\/2013.5.JNS122327"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3808"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1300962"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.8.JNS132603"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600159"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181e9acb2"},{"key":"e_1_2_8_20_1","first-page":"271","volume-title":"Parkinson's Disease and Movement Disorders","author":"Fahn S","year":"1993"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.09.001"},{"key":"e_1_2_8_22_1","unstructured":"Centers for Medicare and Medicaid Services: Physician Fee Schedule; Acute Inpatient PPS. 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