Perspectives on deep brain stimulation for obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by intrusive, fear inducing thoughts (obsessions) and repetitive behaviors aimed at reducing anxiety (compulsions). Left untreated, OCD can cause severe harm in functioning and quality of life to patient and relatives. Standard treatment for OCD consists of cognitive behavioral therapy (CBT) and pharmacotherapy. Despite exhaustive treatment, 10% of patients remain refractory, for which Deep Brain Stimulation (DBS) has been suggested. Over the past decade, DBS trials for OCD demonstrate an responder rate (Yale-Brown obsessive compulsive scale (Y-BOCS) reduction of >35%) of 50% with mostly transient side-effects. Given its efficacy, DBS has been accepted by several countries as last resort treatment. Though health insurance companies in various countries worldwide reimburse DBS, surprisingly, nothing is known about its actual costs and cost-effectiveness. Clarifying this is crucial for further implementation of DBS for OCD. Because distribution of resources should not be solely based on clinical benefit but should also be supported by efficiency. The aim of this study is to investigate the costs involved in the treatment and perform a preliminary economic evaluation comparing costs and effects of DBS versus treatment as usual (TAU).