Introduction: To compare costs of deep brain stimulation (DBS) performed as an awake versus an asleep procedure at a single US academic health center and to compare costs across the University HealthSystem Consortium (UHC) Clinical Data Base.
Methods: Financial data for patients receiving a DBS lead implant were collected and analyzed. Inpatient charges included those associated with the procedure: implantation or replacement of intracranial neurostimulator lead. Outpatient charges included all preoperative charges = 30 days prior to implant and all postoperative charges = 30 days after implant.
The UHC database was queried (January 2011 to March 2014) with the same ICD-9 code. Procedure cost data across like hospitals (27 UHC hospitals including OHSU) conducting similar DBS procedures was compared.
Results: Two hundred and eleven (53 awake and 158 asleep) DBS procedures were performed. Average patient age was 65 ± 9 years and 39% of patients were female. Primary diagnosis was paralysis agitans (61%) followed by essential and other forms of tremor (36%).
Overall average DBS procedure cost was $39,152 ± $5,340. Asleep DBS cost $38,850 ± $4,830, which was not significantly different than the awake DBS cost $40,052 ± $6,604. Standard deviation for asleep DBS was significantly lower (p = 0.05). The median cost for neurostimulator implant lead in 2013 was $34,052 at UHC affiliated hospitals that performed at least five procedures a year. This center’s cost was $17,150 and the observed single academic health center cost for a neurostimulator lead implant was less than the expected cost (ratio; 0.97).
Conclusions: In this analysis, DBS performed as an asleep procedure was associated with a lower cost variation relative to the awake procedure. Furthermore, costs compare favorably to UHC affiliated hospitals. While asleep DBS is not yet standard practice, this center exclusively performs asleep DBS at lower cost than comparable institutions.
Patient Care: Improve patient satisfaction with DBS implant, and reduce costs.
Learning Objectives: Compare costs of DBS surgery under local and general anethesia.