Deep brain stimulation surgeries can cost a lot. It is, therefore, pertinent to understand if you are paying the worth of the surgery or more.

For this, you must understand that there is a difference between the price you are paying and the total cost you are bearing. While the price is the face value of any surgery, the cost for the patient involves everything they are willing to sacrifice to pay for it. In addition to the monetary cost, it involves emotional cost, the cost of time spent, the cost of work lost in the process, etc. Different hospitals or centres offer different values for these secondary costs that the patient has to bear. 

Essentially, the prime cost of the surgery consists of the cost of the three main elements that make a deep brain stimulation surgery successful: correct selection of the patient, correct technique and the programming and medication management after the surgery. However, as patients, you must also look out if the centre offers you a good value for these secondary costs:

• The Cost of Safety: Does the centre have enough experience to prevent complications from DBS and offer you safety? A single mistake in DBS surgeries can cause brain haemorrhage and strokes. 

• The Cost of Long-Term Management: Is the centre offering better long-term management and well-being after the surgery?

• Emotional Cost: Is the centre likely to provide the benefits you’re expecting?

• Travel Cost: How many times do you need to visit before and after the surgery? The less frequently you need to travel, the less frequently you need to miss your work, and the less the travel cost.

What Are The Considerations For The Patient To Evaluate In Determining The Cost

1. General Vs Private Hospital: DBS in India is mainly offered in private sector hospitals only. However, there are certain national-level institutes like NIMHANS, AIIMS, SCTIMST etc. Offering this surgery in public sector as well. Where it is obvious that the cost of this public sector hospital will be much lesser than the private sector hospitals. however, what you gain in cost you compromise in the quality of care and comfort so it will be entirely a patient’s choice to decide as to, which kind of hospital he or she wants to select.
2. Duration Of The Functional Neurosurgical Program: DBS has now become a prestige issue for many hospitals. The dministration of private hospitals a push the doctors to start this program even if they do not have adequate training or expertise. In view to promote these therapies in their hospitals, they cut down the cost of these surgeries dramatically as compared to other surgeries. So many centres which are just starting these therapies, or which are competing against big centres for the patient load, try to offer these surgeries at a huge discount to the patient. However, one has to understand that this is only because either they are not getting an adequate number of patients, or they are just starting this program and they want to push this program. 
3. Infrastructure: DBS is highly equipment-dependent. Equipment, like 3T MRI, Microelectrode equipment monitors, stereotactic systems, planning software etc, are very crucial for successful DBS. Prof. Paresh Doshi, at Jaslok Hospital and Research centre has ensured that not only we have the state of the art equipments (not available at most centres) but two systems, whether it be MER machine or the MRI machine, available at all times for a backup! Ultimately it is the brain surgery, and you do not want to take any chances. 
4. Multidisciplinary Management: Parkinson’s is a complex disease and it requires multidisciplinary input to achieve a good quality of life outcome. As the disease advances, the problems associated with Parkinson’s disease and general medical problems can make the outcome of DBS less effective. You want to enquire as to, how long the Parkinson’s disease program has been running so as to find out the experience and expertise of the multidisciplinary team involved. Once again, at Jaslok Hospital, there are more than 20 years of experience in this multidisciplinary team comprising neurologists, neuropsychologists, psychiatrists, urologists, and gastroenterologists who all contribute to the successful outcome of quality of life for Parkinson’s patients.
5. Finally, The Perfect Outcome: What is a perfect outcome? Less follow-ups, maximal reduction in medicines, no behavioural side effects and continued address to the problems. Sounds like a dream. Not really, it should be surely possible, if you are with an expert team who has a great experience.

So, What Is The Perfect Setup For Undergoing DBS

1. Experienced Team: At least 10 years of DBS practice

2. Skills: At least 150 DBS procedures performed

3. Infrastructure: The hospital should have MRI, MER, the planning system and stereotactic equipment

4. Postoperative Management: Programming experience across various DBS platforms, ideally 15 years, preferably 10 year

Now we have understood the cost, let us review the various options available in India:

EXPERIENCE 

The relative costs of non-rechargeable DBS in General wards in various hospitals.

Most centres with experience and expertise charge more for DBS surgeries because they include the above-mentioned secondary costs in it and save you a lot of money and other losses in the long run. 

Lastly, you must also remember that the price charged by the centre includes several other costs than just that of experience and expertise, such as the average cost of living in the city, the cost of hospitalisation in the city and the type of technique involved. Together, all these secondary costs make up the total cost of the deep brain stimulation surgery.