3.12.2012 Report into Deep Brain Stimulation Published

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The Health Information and Quality Authority have published a health technology assessment on the provision of deep brain stimulation services in Ireland.


Deep brain stimulation is a surgical procedure for the management of motor function symptoms in people with movement disorders, including Parkinson's disease, essential tremor and dystonia, that can no longer be adequately controlled by drug therapy. There is also the potential that this treatment can be used for other conditions.


Currently in Ireland, people are referred to DBS centres abroad for assessment, surgery and follow up care. The Irish health service funds this treatment under the European E11 (Treatment Abroad) scheme, (TAS). Since 1997 it is estimated that over 130 adults have been funded to receive DBS care through this mechanism.


The disadvantages of the scheme are that individual patients incur travel costs and significant inconvenience associated with receiving a procedure and follow up care in another country. People who are otherwise eligible may not be able to receive the treatment due to the costs and burden associated with travel.


An expert advisory group and an evaluation team from HIQA undertook the following research:


-a review of the scientific literature to summarise the available clinical evidence on the effectiveness of DBS technology and to identify guidelines and service standards for its provision in other healthcare systems

- data were obtained from a range of Irish and international experts, including dossiers submitted by commercial companies manufacturing DBS devices

-the likely costs and budget impact over five years for the Irish healthcare system was assessed


The report concludes that a national DBS service will cost the HSE more per patient treated (€20,900 more over ten years) and result in an increase in the overall cost of the service (€1.84 million more over five years) compared to the estimated €4.9 million to treat the same number of patients abroad using the current scheme. The report points out that a key factor in this analysis is the impact of private health insurance. The report recognises the current inconvenience, difficulty and distress for people having to travel overseas, but also points the demands that a DBS service would place on already overstretched neurosurgical and neurology services.


The NAI is very aware of the distress and difficulties experienced by individuals in travelling abroad for surgery and follow up and the need to make this surgery a viable option for more of those individuals who are otherwise eligible but cannot incur the cost or burden associated with travel to another country. The NAI encourages the HSE to review the recommendations carefully in this context.



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