帕金森病脑深部电刺激术的长期成本效益——一项基于标准化经济指标的系统评价

Long-Term Cost-Effectiveness of Deep Brain Stimulation for Parkinson’s Disease—A Systematic Review Based on Standardized Economic Indicators

摘要: 目的：系统评价脑深部电刺激术(DBS)治疗帕金森病(PD)的长期成本效益，为卫生决策提供循证依据。方法：检索中英文数据库截至2025年5月的DBS经济学评价研究。采用PRISMA指南进行文献筛选，应用ECOBIAS工具评估偏倚风险。通过GDP平减指数与购买力平价(PPP)将各研究增量成本效果比(ICER)标准化为2023年美元(USD)，并进行定性综合与多维度亚组分析。结果：纳入22项研究，方法学质量中等。成本效益结论高度依赖评估时限：短期(≤3年)分析受高昂初始手术成本驱动，ICER通常超过支付意愿(WTP)阈值；而在长期(≥5年)或终生视角下，标准化ICER中位数约为25,000~45,000 USD/QALY，成本效益显著。相较于常规药物疗法，DBS在长期模型中呈现较大经济优势。亚组分析显示，高收入国家因节约护理成本而效益明显；中高收入国家则因设备成本较高，其ICER接近支付意愿阈值上限。结论：长期视角下，DBS是晚期PD具有成本效益的治疗选择，且优于药物治疗和其他疗法。决策者应关注长期卫生技术评估结果。

Abstract: Objective: To systematically evaluate the long-term cost-effectiveness of deep brain stimulation (DBS) for Parkinson’s disease (PD) and provide evidence-based support for health policy decision-making. Methods: Chinese and international databases were searched for economic evaluations of DBS published up to May 2025. Literature screening was conducted in accordance with the PRISMA guidelines, and risk of bias was assessed using the ECOBIAS tool. Incremental cost-effectiveness ratios (ICERs) reported in the included studies were standardized to 2023 US dollars (USD) using GDP deflators and purchasing power parity (PPP). Qualitative synthesis and multidimensional subgroup analyses were then performed. Results: A total of 22 studies were included, with overall moderate methodological quality. Cost-effectiveness conclusions were highly dependent on the evaluation time horizon. In short-term analyses (≤3 years), the high initial surgical costs of DBS typically resulted in ICERs exceeding willingness-to-pay (WTP) thresholds. In contrast, under long-term (≥5 years) or lifetime perspectives, the median standardized ICER was approximately 25,000~45,000 USD per QALY, indicating favorable cost-effectiveness. Compared with other therapeutic strategies, DBS demonstrated greater economic advantages in long-term models. Subgroup analyses showed that in high-income countries, DBS produced substantial economic benefits mainly through reductions in long-term care costs; whereas in upper-middle-income countries, higher device costs resulted in ICERs approaching the upper limit of WTP thresholds. Conclusion: From a long-term perspective, DBS is a cost-effective treatment option for advanced PD and is superior to drug therapy and other treatments. Decision-makers should pay attention to the results of long-term health technology assessment.