Essential tremor is the most common type of movement disorder and most often affects the dominant hand. Essential tremor is estimated to affect up to 4 percent of Canadian adults, with an increase in severity and prevalence with age. As the tremor gets worse, it can negatively impact quality of life, limiting a person’s ability to perform daily activities such as eating, writing, walking, and self-care.
The first treatment available to manage essential tremor is medication, but about 50 percent of people do not respond well to medication or are unable to tolerate the side effects. The only other available treatment is neurosurgery (brain surgery), but the standard surgical treatments available are invasive procedures that involve opening the skull.
Magnetic resonance-guided focused ultrasound (MRgFUS) neurosurgery is a new, noninvasive surgical technology for the treatment of essential tremor. Since MRgFUS neurosurgery is noninvasive, it does not have the same surgical risks as invasive procedures.
Health Quality Ontario studied the effectiveness, safety, cost-effectiveness, and budget impact of publicly funding MRgFUS neurosurgery, as well as the preferences and values of people with essential tremor with regard to treatment options.
Our assessment showed that MRgFUS neurosurgery is generally safe and effective at reducing tremor severity, improving quality of life, and helping people get back to their daily activities. MRgFUS neurosurgery may be a treatment option for people with moderate to severe essential tremor for whom medication has not worked and who are unable to undergo invasive surgery or who are unwilling to accept the risks of invasive surgery.
People with essential tremor whom we interviewed who had undergone MRgFUS neurosurgery reported positive experiences with the procedure and felt that it had improved their quality of life by substantially reducing their tremors.
The cost-effectiveness analysis shows that for people with essential tremor who cannot undergo invasive neurosurgery, MRgFUS neurosurgery represents good value for money compared with no surgery. For people who can undergo invasive neurosurgery, MRgFUS neurosurgery is one of several reasonable options. The additional cost to the province to publicly fund MRgFUS neurosurgery at the current level of 48 cases per year would be about $1 million per year for the next 5 years.
The Ministry of Health and Long-Term Care is currently reviewing this recommendation.
The Ministry has a standardized process in place to review Health Quality Ontario recommendations. This takes into consideration Ministry priorities, implementation options, the need for consultation with impacted stakeholders, and funding considerations.