Deep Brain Stimulation Compared With Contingency Management for the Treatment of Cocaine Use Disorders: A Threshold and Cost-Effectiveness Analysis

Fiene Marie Kuijper; Uma V Mahajan; Seul Ku; Daniel A N Barbosa; Sheila M Alessi; Sherman C Stein; Kyle M Kampman; Brandon S Bentzley; Casey H Halpern

doi:10.1111/ner.13410

Deep Brain Stimulation Compared With Contingency Management for the Treatment of Cocaine Use Disorders: A Threshold and Cost-Effectiveness Analysis

Neuromodulation. 2022 Feb;25(2):253-262. doi: 10.1111/ner.13410.

Authors

Fiene Marie Kuijper¹, Uma V Mahajan¹, Seul Ku², Daniel A N Barbosa¹, Sheila M Alessi³, Sherman C Stein⁴, Kyle M Kampman⁵, Brandon S Bentzley⁶, Casey H Halpern⁷

Affiliations

¹ Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
² Department of Medicine, Stanford University, Stanford, CA, USA.
³ UConn Health, Farmington, CT, USA.
⁴ Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁵ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: bentzley@stanford.edu.
⁷ Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: chalpern@stanford.edu.

PMID: 35125144
DOI: 10.1111/ner.13410

Abstract

Objectives: Cocaine is the second most frequently used illicit drug worldwide (after cannabis), and cocaine use disorder (CUD)-related deaths increased globally by 80% from 1990 to 2013. There is yet to be a regulatory-approved treatment. Emerging preclinical evidence indicates that deep brain stimulation (DBS) of the nucleus accumbens may be a therapeutic option. Prior to expanding the costly investigation of DBS for treatment of CUD, it is important to ensure societal cost-effectiveness.

Aims: We conducted a threshold and cost-effectiveness analysis to determine the success rate at which DBS would be equivalent to contingency management (CM), recently identified as the most efficacious therapy for treatments of CUDs.

Materials and methods: Quality of life, efficacy, and safety parameters for CM were obtained from previous literature. Costs were calculated from a societal perspective. Our model predicted the utility benefit based on quality-adjusted life-years (QALYs) and incremental-cost-effectiveness ratio resulting from two treatments on a one-, two-, and five-year timeline.

Results: On a one-year timeline, DBS would need to impart a success rate (ie, cocaine free) of 70% for it to yield the same utility benefit (0.492 QALYs per year) as CM. At no success rate would DBS be more cost-effective (incremental-cost-effectiveness ratio <$50,000) than CM during the first year. Nevertheless, as DBS costs are front loaded, DBS would need to achieve success rates of 74% and 51% for its cost-effectiveness to exceed that of CM over a two- and five-year period, respectively.

Conclusions: We find DBS would not be cost-effective in the short term (one year) but may be cost-effective in longer timelines. Since DBS holds promise to potentially be a cost-effective treatment for CUDs, future randomized controlled trials should be performed to assess its efficacy.

Keywords: Cocaine use disorders; contingency management; cost-effectiveness; deep brain stimulation.

MeSH terms

Cocaine*
Cost-Benefit Analysis
Deep Brain Stimulation*
Humans
Parkinson Disease* / therapy
Quality of Life
Quality-Adjusted Life Years

Substances

Cocaine