{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:53:45Z","timestamp":1785542025426,"version":"3.56.0"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Deep brain stimulation (DBS) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (OCD). Despite being more costly than neuroablative procedures of comparable efficacy, DBS has gained popularity over the years for its reversibility and adjustability. Although the cost-effectiveness of DBS has been investigated extensively in movement disorders, few economic analyses of DBS for psychiatric disorders exist. In this study, the authors present the first cost-effectiveness analysis of DBS for treatment-resistant OCD in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors developed four decision analytical models to compare the cost-effectiveness of DBS with treatment as usual (TAU) for OCD, varying either the device type (i.e., nonrechargeable or rechargeable) or the time horizon (i.e., 3 or 5 years) in each model. Treatment response and complication rates were based on a literature review. Published algorithms were used to convert Yale-Brown Obsessive Compulsive Scale scores into utility scores reflecting improvements in quality of life. Costs were approached from the healthcare sector perspective and were drawn primarily from Medicare facility and physician reimbursement rates. For each model, a Monte Carlo simulation (n = 100,000) and probabilistic sensitivity analysis were performed to estimate the incremental cost-effectiveness ratio (ICER) in US dollars per quality-adjusted life year (QALY).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Data from 249 and 265 treatment-resistant OCD patients from the published literature who received DBS and had sufficient follow-up in 3- and 5-year models, respectively, were included. When conventional US willingness-to-pay (WTP) thresholds were used, nonrechargeable DBS models were less cost-effective (3-year ICER: $108,431\/QALY; 5-year ICER: $203,202\/QALY) and rechargeable DBS models were more cost-effective (3-year ICER: $49,363\/QALY; 5-year ICER: $41,495\/QALY) than TAU. At a WTP threshold of $100,000\/QALY, rechargeable DBS devices were moderately more cost-effective than TAU at 3 and 5 years in 100% of iterations. At a WTP threshold of $50,000\/QALY, rechargeable DBS devices were definitively more cost-effective than TAU at 3 and 5 years in 54% and 89% of iterations, respectively. When using WHO WTP conventions, 3- and 5-year nonrechargeable models were cost-effective in 100% and 84% of iterations, and 3- and 5-year rechargeable models were highly cost-effective in 99% and 100% of iterations, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Rechargeable DBS models were cost-effective for treatment-resistant OCD compared with TAU. Nonrechargeable DBS models may be cost-effective, especially with improvement in battery longevity and changes in accepted WTP thresholds.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.7.jns232642","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T20:25:39Z","timestamp":1735935939000},"page":"1225-1234","source":"Crossref","is-referenced-by-count":10,"title":["Cost-effectiveness analysis of deep brain stimulation versus treatment as usual for treatment-resistant obsessive-compulsive disorder"],"prefix":"10.3171","volume":"142","author":[{"given":"Ricardo A.","family":"Najera","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E.","family":"Kabotyanski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole C.","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean T.","family":"Gregory","sequence":"additional","affiliation":[{"name":"Meadows Mental Health Policy Institute, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrish","family":"Anand","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Shofty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole R.","family":"Provenza","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Storch","sequence":"additional","affiliation":[{"name":"Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne K.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer A.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Mol Psychiatry","first-page":"53","article-title":"The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication","volume":"15","author":"Ruscio AM","year":"2010","unstructured":"Ruscio AM, Stein DJ, Chiu WT, Kessler RC. 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Mol Psychiatry. 2019;24(2):218\u2013240."},{"issue":"4","key":"b11","series-title":"J Neurol Neurosurg Psychiatry","first-page":"469","article-title":"Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study","volume":"90","author":"Kumar KK","year":"2019","unstructured":"Kumar KK, Appelboom G, Lamsam L,  Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study. J Neurol Neurosurg Psychiatry. 2019;90(4):469\u2013473."},{"key":"b12","series-title":"Front Psychiatry","first-page":"640832","article-title":"Magnetic resonance-guided focused ultrasound surgery for obsessive-compulsive disorders: potential for use as a novel ablative surgical technique","volume":"12","author":"Chang KW","year":"2021","unstructured":"Chang KW, Jung HH, Chang JW. 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