{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:58:31Z","timestamp":1783774711680,"version":"3.55.0"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,12,27]],"date-time":"2018-12-27T00:00:00Z","timestamp":1545868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Radiofrequency thalamotomy and deep brain stimulation are current treatments for moderate to severe medication\u2010refractory essential tremor. However, they are invasive and thus carry risks. Magnetic resonance\u2010guided focused ultrasound is a new, less invasive surgical option. The objective of the present study was to determine the cost\u2010effectiveness of magnetic resonance\u2010guided focused ultrasound compared with standard treatments in Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cost\u2010utility analysis using a Markov cohort model. We compared magnetic resonance\u2010guided focused ultrasound with no surgery in people ineligible for invasive neurosurgery and with radiofrequency thalamotomy and deep brain stimulation in people eligible for invasive neurosurgery. In the reference case analysis, we used a 5\u2010year time horizon and a public payer perspective and discounted costs and benefits at 1.5% per year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared with no surgery in people ineligible for invasive neurosurgery, magnetic resonance\u2010guided focused ultrasound cost $21,438 more but yielded 0.47 additional quality\u2010adjusted life years, producing an incremental cost\u2010effectiveness ratio of $45,817 per quality\u2010adjusted life year gained. In people eligible for invasive neurosurgery, magnetic resonance\u2010guided focused ultrasound was slightly less effective but much less expensive compared with the current standard of care, deep brain stimulation. The results were sensitive to assumptions regarding the time horizon, cost of magnetic resonance\u2010guided focused ultrasound, and probability of recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In people ineligible for invasive neurosurgery, the incremental cost\u2010effectiveness ratio of magnetic resonance\u2010guided focused ultrasound versus no surgery is comparable to many other tests and treatments that are widely adopted in high\u2010income countries. In people eligible for invasive neurosurgery, magnetic resonance\u2010guided focused ultrasound is also a reasonable option. \u00a9 2018 International Parkinson and Movement Disorder Society<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.27587","type":"journal-article","created":{"date-parts":[[2018,12,27]],"date-time":"2018-12-27T15:18:09Z","timestamp":1545923889000},"page":"735-743","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Cost\u2010Effectiveness of Magnetic Resonance\u2010Guided Focused Ultrasound for Essential Tremor"],"prefix":"10.1002","volume":"34","author":[{"given":"Chunmei","family":"Li","sequence":"first","affiliation":[{"name":"Health Quality Ontario  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Gajic\u2010Veljanoski","sequence":"additional","affiliation":[{"name":"Health Quality Ontario  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis K.","family":"Schaink","sequence":"additional","affiliation":[{"name":"Health Quality Ontario  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Higgins","sequence":"additional","affiliation":[{"name":"Health Quality Ontario  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Fasano","sequence":"additional","affiliation":[{"name":"Morton and Gloria Shulman Movement Disorders Centre, Edmond J. Safra Program in Parkinson's Disease Toronto Western Hospital, University Health Network  Toronto Ontario Canada"},{"name":"Division of Neurology University of Toronto  Toronto Ontario Canada"},{"name":"Krembil Research Institute  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Sikich","sequence":"additional","affiliation":[{"name":"Health Quality Ontario  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irfan","family":"Dhalla","sequence":"additional","affiliation":[{"name":"Health Quality Ontario  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Ng","sequence":"additional","affiliation":[{"name":"Health Quality Ontario  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22838"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-012-6628-x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2015.09.012"},{"issue":"13","key":"e_1_2_9_5_1","first-page":"225","article-title":"The differential diagnosis and treatment of tremor","volume":"111","author":"Botzel K","year":"2014","journal-title":"Dtsch Arztebl Int"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26383"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23195"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1015-9584(09)60404-8"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000163769.28552.CD"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2015.01.013"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40349-017-0096-9"},{"key":"e_1_2_9_12_1","unstructured":"Insightec. 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