OBJECTIVES: To define the economic and organizational hospital advantages of MRgFUS implementation in Italy, for the unilateral treatment of essential tremor (mr-ET), compared to unilateral Deep Brain Stimulation (DBS).

METHODS: A time-driven activity-based costing approach was developed to define MRgFUS inpatient procedure and DBS economic resources absorption, on an annual basis. The direct hospital costs related to pre-surgery activities, patients’ admission, surgery, and hospitalization were considered. A Budget Impact Analysis was conducted to verify MRgFUS’ economic sustainability based on the Italian population with mr-ET. The organizational analysis includes the potential advantages in terms of increased beds’ availability due to shorter hospitalization.

RESULTS: MRgFUS represents the less expensive treatment option, generating an economic saving per patient of 30% with respect to DBS (19,962€ vs 28,337€). When considering the overall Italian adult population with mr-ET that seek treatment (20.3%, Romero et al.,2012), being refractory to medication (50%, Zesiewicz et al.,2011) and eligible to surgery (85%, Health Quality Ontario,2018), thus representing 37,679 mr-ET patients, an overall economic benefit of 29% emerged.

Furthermore, given a difference in the overall length of stay derived from Italian clinical practice (MRgFUS:2 nights; DBS:6.7 nights), an organizational advantage of 69% emerged (in terms of reductions in hospitalization days, on an annual basis) with a positive impact on the accessibility of care.

CONCLUSIONS: Results revealed MRgFUS economic and organizational sustainability, demonstrating that treating all eligible mr-ET patients with DBS is unlikely to be an effective strategy from a resource allocation perspective. This is even more relevant in view of the early but promising results of MRgFUS in the treatment of patients with Tremor-Dominant Parkinson’s Disease (Bond et al.,2017), asymmetric Parkinson’s Disease (Martinez et al.,2020), and advanced PD patients (Krishna et al.,2023). MRgFUS may be considered a valid alternative to DBS, encouraging regional and national healthcare authorities to ensure its adoption.