Cost-effectiveness of repetitive transcranial magnetic stimulation versus antidepressant therapy for treatment-resistant depression

Nguyen, Kim-Huong and Gordon, Louisa G. (2015) Cost-effectiveness of repetitive transcranial magnetic stimulation versus antidepressant therapy for treatment-resistant depression. Value in Health, 18 5: 597-604. doi:10.1016/j.jval.2015.04.004


Author Nguyen, Kim-Huong
Gordon, Louisa G.
Title Cost-effectiveness of repetitive transcranial magnetic stimulation versus antidepressant therapy for treatment-resistant depression
Journal name Value in Health   Check publisher's open access policy
ISSN 1098-3015
1524-4733
Publication date 2015-07-01
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.jval.2015.04.004
Open Access Status Not yet assessed
Volume 18
Issue 5
Start page 597
End page 604
Total pages 8
Place of publication New York, NY., United States
Publisher Elsevier
Language eng
Abstract Background: Repetitive transcranial magnetic stimulation (rTMS) therapy is a clinically safe, noninvasive, nonsystemic treatment for major depressive disorder. Objective: We evaluated the costeffectiveness of rTMS versus pharmacotherapy for the treatment of patients with major depressive disorder who have failed at least two adequate courses of antidepressant medications. Methods: A 3-year Markov microsimulation model with 2-monthly cycles was used to compare the costs and quality adjusted life years (QALYs) of rTMS and a mix of antidepressant medications (including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclics, noradrenergic and specific serotonergic antidepressants, and monoamine oxidase inhibitors). The model synthesized data sourced from published literature, national cost reports, and expert opinions. Incremental cost utility ratios were calculated, and uncertainty of the results was assessed using univariate and multivariate probabilistic sensitivity analyses. Results: Compared with pharmacotherapy, rTMS is a dominant/cost-effective alternative for patients with treatment-resistant depressive disorder. The model predicted that QALYs gained with rTMS were higher than those gained with antidepressant medications (1.25 vs. 1.18 QALYs) while costs were slightly less (AU $31,003 vs. AU $31,190). In the Australian context, at the willingness-to-pay threshold of AU $50,000 per QALY gain, the probability that rTMS was cost-effective was 73%. Sensitivity analyses confirmed the superiority of rTMS in terms of value for money compared with antidepressant medications. Conclusions: Although both pharmacotherapy and rTMS are clinically effective treatments for major depressive disorder, rTMS is shown to outperform antidepressants in terms of cost-effectiveness for patients who have failed at least two adequate courses of antidepressant medications. Copyright (C) 2015, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
Keyword Randomized Controlled-Trial
Star-Asterisk-D
Major Depression
Electroconvulsive-Therapy
Metaanalysis
Multisite
Efficacy
Disorder
Tms
Australia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: UQ Centre for Clinical Research Publications
 
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