Abstract
OBJECTIVES: MRgFUS has emerged as a life-changing solution for patients with essential tremor (ET). The aim of the study was a multi-dimensional evaluation of the benefits concerning MRgFUS introduction, in comparison with the standard of care, Deep Brain Stimulation (DBS), in Italy. METHODS: In 2017, an Health Technology Assessment was conducted assuming the hospital perspective. Information was retrieved via literature review and collected using qualitative/quantitative questionnaires, covering the 9 EUnetHTA Core Model dimensions and applying a final MCDA approach. RESULTS: In the Italian setting, 48,923 ET patients emerged to be eligible for MRgFUS or DBS treatments, because of the failure of pharmacological treatment. In the comparison between the two alternative technologies, the efficacy profile would be superimposable, in terms of relief from hand tremor, whereas MRgFUS would be the preferable technology from a safety point of view, because of less-invasiveness. Its implementation into the clinical practice would generate economic advantages, ranging from -34% to -67%, on the basis of the use of MRgFUS that consumes fewer economic resources per patient, than DBS (V9,669 vsV30,686, p=0.000). The innovative technology would also have a positive organizational impact, considering: operating capacity (time release in minutes from -25% to -49%), and the length of stay (3 vs 7.70 days, p=0.000). Patients treated with MRgFUS would experience i) a reduction in their "out-of-pocket" expenditure related to hospitalization (V404 vsV1,036, p=0.000) and ii) a quicker return to regular activities (2/3 vs 30/40 days after discharge). CONCLUSIONS: The results suggested that MRgFUS could be considered an advantageous technological alternative for the treatment of patients with essential tremor, paving the way for the definition of a dedicated national reimbursement tariff, making the health service more efficient and effective. Furthermore, hospital could acquire the innovative technology, covering the initial investment cost by implementing 57-63 procedures per year.