Parkinson's Surgery: Costs, Benefits, and Long-Term Effects

Q: Parkinson's Surgery: Costs, Benefits, and Long-Term Effects

Hello： <br>1. <br>The National Health Insurance Administration included "Deep Brain Stimulators" in the health insurance benefits starting from January 1, 2015. <br>Subsequently, on July 1, 2016, the reimbursement regulations were relaxed, removing the lifetime limit of one-time

Surgery for Parkinson's Disease

Hello Doctor, my mother was diagnosed with Parkinson's disease in 2012 and has been on medication for many years.
Recently, she has been experiencing numerous side effects, such as involuntary movements and a feeling that the medication is not lasting long enough, which has caused her to walk unsteadily.
During her last follow-up with the neurologist, the doctor suggested an evaluation for surgery and referred her to a neurosurgeon.
However, since I was not present, my mother did not receive much information.

I would like to ask, I heard that surgery is covered by health insurance now, but I am unsure if there will still be some out-of-pocket expenses.
Additionally, I heard that the battery needs to be replaced every seven years; is the replacement of the battery also covered by health insurance? Lastly, I would like to know if the outcomes after surgery are significantly better than just medication alone.
I have heard that while symptoms can be greatly alleviated in the first few years, they may worsen again after a few years instead of remaining stable at the post-surgery condition.
Thank you for your response!

Mr. Lin, 30~39 year old female. Ask Date: 2019/09/16

Dr. Hong Weibin reply Neurology

Hello:
1.
The National Health Insurance Administration included "Deep Brain Stimulators" in the health insurance benefits starting from January 1, 2015.
Subsequently, on July 1, 2016, the reimbursement regulations were relaxed, removing the lifetime limit of one-time reimbursement.
Recently, during a meeting to jointly draft the drug reimbursement items and payment standards for the National Health Insurance, it was decided to include three components required for the use of the "Deep Brain Stimulator," namely the lead, lead extension, and lead anchor, into the health insurance coverage, effective from August 1, 2019.
As for out-of-pocket expenses, they may pertain to consumables needed during the surgical procedure.
It is recommended to directly consult the neurosurgeon performing the surgery regarding any additional costs.
2.
The current reimbursement regulations are as follows: the provisions do not explicitly state whether the battery is reimbursed only once; this medical device has been open for reimbursement since 2016.
However, the use of expensive medical devices must undergo prior review by the National Health Insurance, and costs will only be reimbursed if approved by experts.
The following conditions must be met (effective from August 1, 2019):
(1) The patient must have primary Parkinson's disease.

(2) The disease must have been present for more than five years, and the patient must have been assessed by a medical center as unresponsive to medication for at least one year or unable to continue medication due to adverse reactions from long-term use.

(3) The patient must be in good overall health, with no dementia (Mini Mental Status Exam score must be greater than 24), no other severe internal or external diseases (such as coronary artery disease, renal failure, or cancer), and no psychiatric disorders that cannot be controlled by medication.

(4) The patient's brain MRI must be normal.

3.
Imaging diagnostic data and relevant medical history must be submitted, and approval must be obtained from a special project review committee composed of members recommended by the Taiwan Neurological Society and the Taiwan Neurosurgical Society before use.

4.
The use of health insurance-covered special materials such as leads, lead extensions, and lead anchors is limited to patients with implanted deep brain stimulators and is restricted to a one-time application.

5.
Parkinson's disease is a neurodegenerative disorder.
Current treatments, whether pharmacological or through deep brain stimulation, aim to slow the degenerative process but cannot completely prevent neuronal death.
Therefore, symptoms may still gradually worsen.
You can refer to the last section on the treatment of Parkinson's disease and subthalamic nucleus stimulation in the introduction to Parkinson's disease by National Taiwan University Hospital (http://www.pdcenterntuh.org.tw/ContentAspx/Browser00.aspx?isClass=3&setTable=1&type=3).

Wishing you a speedy recovery.

References:
1.
Ministry of Health and Welfare Press Release.
https://www.mohw.gov.tw/cp-16-48438-1.html
2.
National Health Insurance Administration Special Materials Inquiry (https://www1.nhi.gov.tw/QueryN/Query4.aspx), reimbursement regulation code: "I203-8."

Reply Date: 2019/09/16

More Info

Parkinson's disease is a progressive neurological disorder that affects movement and can lead to a variety of symptoms, including tremors, stiffness, and difficulty with balance and coordination. For patients like your mother, who have been on medication for several years and are experiencing significant side effects, surgical options may be considered.
One common surgical intervention for Parkinson's disease is Deep Brain Stimulation (DBS). This procedure involves implanting electrodes in specific areas of the brain to help regulate abnormal impulses. The benefits of DBS can be substantial, often leading to significant improvements in motor symptoms and a reduction in medication requirements. However, it is essential to understand the costs, benefits, and long-term effects associated with this surgery.

Costs and Insurance Coverage
In many healthcare systems, including those in the United States, DBS surgery may be covered by insurance, including Medicare and Medicaid, provided that certain criteria are met. These criteria typically include a confirmed diagnosis of Parkinson's disease, significant motor symptoms that are not adequately controlled by medication, and the absence of severe cognitive impairment. However, while the surgery itself may be covered, there can be additional costs associated with pre-operative evaluations, hospital stays, and post-operative care that may not be fully covered by insurance.

Regarding the battery replacement for the DBS device, it is true that the batteries typically need to be replaced every 3 to 5 years, depending on usage and the specific device. In many cases, the replacement procedure is also covered by insurance, but it is crucial to verify this with your insurance provider to understand any potential out-of-pocket expenses.

Long-Term Effects and Efficacy
The long-term effects of DBS can vary from patient to patient. Many individuals experience significant improvements in their symptoms for several years following the surgery. However, it is important to note that Parkinson's disease is progressive, and while DBS can help manage symptoms, it does not halt the progression of the disease. Over time, some patients may find that their symptoms gradually return or that they experience new symptoms as the disease advances.
In general, the initial years after surgery can be marked by substantial improvements, but ongoing management and adjustments to the stimulation settings may be necessary. Regular follow-ups with a neurologist or movement disorder specialist are essential to monitor the effectiveness of the treatment and make any necessary adjustments.

Conclusion
In summary, considering surgery for Parkinson's disease is a significant decision that requires careful evaluation of the potential benefits and risks. It is essential to have a thorough discussion with your mother's neurologist and the neurosurgeon to understand the specific details regarding costs, insurance coverage, and the expected outcomes of the surgery. Additionally, it may be helpful to connect with support groups or resources for patients undergoing similar treatments to gain insights and share experiences. This comprehensive approach will help ensure that your mother receives the best possible care tailored to her needs.

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