Assessment of the Business Case for a Deep Brain Stimulation Neurosurgical Programme for Movement DisordersNational Service & Technology Review Advisory Committee (NSTR)
Date of publication: November 2008
Context
The National Service and Technology Review Advisory Committee (NSTR) considered the proposal for change for a national stereotactic Deep Brain Stimulation neurosurgical programme for movement disorders in the context of:
- Deep Brain Stimulation (DBS) is a proven intervention for movement disorders, particularly for Parkinson’s disease, and has become an important main-stream treatment.
- Since 1999, the Ministry of Health has provided some limited funding via the High Cost Treatment Programme for New Zealand patients to receive DBS surgery in Australia.
- Current selection of patients for this programme is made through a small national committee comprised of neurologists and neurosurgeons from the main centres. The programme is supported by the Auckland City Hospital Movement Disorders Clinic.
- DBS may well have additional applications in future in other areas including the treatment of refractory epilepsy, mood disorders, obsessive-compulsive disorders and other psychiatric complaints. The utility of DBS in these disorders is being investigated.
Recommendations
The National Service and Technology Review Advisory Committee (NSTR)recommends that the DHB CEOs and the Ministry of Health’s Executive Leadership Team note that:
1. DBS is a proven intervention already publicly funded for New Zealanders via the Ministry of Health’s High Cost Treatment Pool.
2. At present up to six DBS cases per year are referred to Australia.
3. All six members of the national DBS Committee agree that a DBS service should be provided in Auckland.
4. The clinical capability and physical infrastructure to provide a national service are already in place at Auckland DHB.
5. The direct surgical costs from the Australian provider are currently AUS$86,253 (equivalent to NZ$109,955 on 18 July 2008) per patient. The estimated Auckland City Hospital costs per patient are NZ$73,689 – a difference of NZ$36,266 per patient.
6. Based on six patients per annum, savings for the New Zealand health system would be NZ$217,596 (for direct surgical costs). These savings do not include the costs for travel, accommodation etc for which even greater savings may be expected to be realised.
7. Given the extension of indications for DBS in movement disorders and the trend to operate on patients with Parkinson’s disease at an earlier stage, it is anticipated that the numbers referred for surgery will modestly increase over time.
8. NSTR has not considered the matter of additional funding beyond the current level of funding.
9. DBS is currently funded from the High Cost Treatment Pool and the Ministry’s view is that, subject to agreement by Auckland DHB to provide the service, DBS should be funded from the National Services Top Slice.
NSTR recommends that the DHB CEOs and the Ministry’s Executive Leadership Team agree that:
10. Auckland DHB establishes a national DBS service.
11. Funding for the national DBS service should be negotiated between the Ministry of Health and Auckland DHB.
Related information
Service Planning and New Health Intervention Assessment (SPNIA)
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Publishing information
Date of publication: November 2008
ISBN numbers: 978-0-478-31850-0 (Online)
HP number: 4705
Citation: Ministry of Health. 2008. Assessment of the Business Case for a Deep Brain Stimulation Neurosurgical Programme for Movement Disorders. Wellington: Ministry of Health. |
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