Objective: Assess the effect of insurance type on deep brain stimulation (DBS) outcomes, and identify risk factors for progression to assisted ambulation and dependency (home health or assisted living) in DBS patients.

Background: DBS is indicated for medication-resistant movement disorders. Despite its efficacy in symptom management [1] and long-term cost savings [2], variability in DBS use secondary to insurance status has been observed [3]. Resultant inequities in DBS use may influence functional outcomes.

Method: A single-center retrospective cohort study of DBS patients from 2012-2024 was conducted. Univariate analysis assessed the association of insurance type (Medicare, Medicaid, private) with baseline characteristics (age, MDS-UPDRS-III scores). Survival analysis (time to event) evaluated associations between these characteristics and functional outcomes (assistive ambulation device use, assisted living).

Results: Univariate analysis found Medicaid patients were younger (n=12, 49±13 v n=74, 65±10, p<0.01) and Medicare patients were older at pre-op assessment (n=50, 65±12 v n=36, 59±11, p=0.01). Privately insured patients had lower pre-op MDS-UPDRS-III OFF (n=19, 36±14 v n=12, 53±27, p=0.04) and ON scores (n=18, 19±9 v n=12, 34±23, p=0.01). Medicare patients were older at transition to assisted ambulation (n=14, 74±6 v n=5, 66±8, p=0.03). Patients eventually using a walker had higher pre-op MDS-UPDRS-III OFF (n=21, 47±21 v n=10, 34±19, p=0.02) and ON scores (n=21, 28±19 v n=9, 17±13, p=0.03). Using survival analysis, higher baseline MDS-UPDRS-III ON scores associated with faster progression to disability (HR 1.56, p=0.03) and dependency (HR 2.31, p=0.01); association with disability remained after controlling for age (p=0.03) and sex (p=0.008) while that with dependency remained after controlling for age (p=0.01). Higher baseline MDS-UPDRS-III OFF scores also associated with faster progression to dependency (HR 2.00, p=0.03), which remained significant after controlling for age (p=0.008) but not sex (p=0.78).

Conclusion: Medicare patients are younger at DBS implantation but have higher symptom burden per MDS-UPDRS-III scores. Higher baseline MDS-UPDRS-III scores correlated with faster progression to assisted ambulation and living. Privately insured patients may have lower symptom burden at implantation. These findings have implications for equitable DBS provision, pre-op counseling, and prognosis.

References: 1. Hitti FL, Ramayya AG, McShane BJ, Yang AI, Vaughan KA, Baltuch GH. Long-term outcomes following deep brain stimulation for Parkinson’s disease. J Neurosurg. 2019 Jan 18;1–6.
2. Becerra JE, Zorro O, Ruiz-Gaviria R, Castañeda-Cardona C, Otálora-Esteban M, Henao S, et al. Economic analysis of deep brain stimulation in Parkinson disease: Systematic review of the literature. World Neurosurg. 2016 Sep;93:44–9.
3. Sarica C, Conner CR, Yamamoto K, Yang A, Germann J, Lannon MM, et al. Trends and disparities in deep brain stimulation utilization in the United States: a Nationwide Inpatient Sample analysis from 1993 to 2017. Lancet Reg Health Am. 2023 Oct;26:100599.

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-insurance-and-risk-factors-on-dbs-outcomes/