Objective: We aimed to obtain valid data on deep brain stimulation (DBS) treatments in Hungary, assessing differences between centers and determining the number of de novo surgeries, replacements, reoperations and immediate complications.

Background: DBS has been available in Hungary since 2001. The public funding of DBS treatments in Hungary is characterized by a fixed budget system for all neuromodulation modalities including spinal cord stimulation (SCS) and replacement, as well.

Method: We aimed to obtain valid data on DBS treatments in Hungary, assessing differences between the 5 centers and determining the number of de novo surgeries, replacements, operations, and immediate complications using the National Health Insurance Fund of Hungary data.

Results: 3780 neuromodulation interventions were reported in 2033 patients during the study period.  Although 62.4% (n=1268) of patients were considered DBS patients, only 55.9% (n=2113) of the procedures were DBS-related. While around 41-42% of all neuromodulations were de novo DBS implantations around 2014-15, only 27.8% were de novo DBS implantations in 2024. The differences between the five neuromodulation centers are also surprisingly large, with the ratio of DBS vs. all neuromodulations varying between 27.3-95.3%.

The residence of patients receiving DBS treatment showed a heterogeneous distribution. The proportion of patients receiving DBS treatment is greater than 2/10,000 inhabitants in 1 county (Baranya, 2.2) and less than 1/10,000 in 3 counties out of the 20. The rate of generator replacements has increased steadily and dynamically from 23.3% in 2010 to 50.4% in 2024. A total of 62 cases (2.9%) were coded as DBS reoperations, while the surgical mortality rate was 0.2%. Ninety cases reported immediate complications, of which 56 were infections.

Conclusion: In countries with a fixed budget, such as Hungary, the number of DBS treatments is significantly limited by the replacement rate and competing modalities. Our data showed that the immediate complications and mortality rates were within acceptable limits.

Currently, different indications (e.g. pain vs. Parkinson’s disease) compete for funding. This theoretically provides a possibility that less technically and professionally demanding SCS treatment may be preferred by some care settings over more complex DBS treatment limitaing the funding available for DBS.

Residence of patients with DBS by county.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-financial-limitations-of-fixed-budget-deep-brain-stimulation-treatment-in-hungary-should-we-implant-new-patients-or-replace-the-old-generators/