Skip to main content
SpringerLink
Log in

Cost-effectiveness of transcranial magnetic stimulation in the treatment of major depression: a health economics analysis

Advances in Therapy volume 26, pages 346–368 (2009)Cite this article

An Erratum to this article was published on 01 July 2009

Abstract

Introduction

Transcranial magnetic stimulation (TMS) is a novel antidepressant therapy shown to be effective and safe in pharmacotherapy-resistant major depression. The incremental cost-effectiveness and the direct cost burden compared with sham treatment were estimated, and compared with the current standard of care.

Methods

Healthcare resource utilization data were collected during a multicenter study (n=301) and a decision analysis was used to stratify the 9-week treatment outcomes. A Markov model with an acute-outcome severity-based risk of relapse was used to estimate the illness course over a full year of treatment follow-up. These model estimates were also compared to best estimates of outcomes and costs of pharmacotherapy treatment, using the published STAR*D outcomes. The cost-effectiveness of TMS was described using an incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained and on a direct cost per patient basis across a varying range of assumptions. The model’s sensitivities to costs due to losses in work productivity and to caregiver time were also examined.

Results

Compared with sham treatment and at a cost of US$300 per treatment session, TMS provides an ICER of US$34,999 per QALY, which is less than the “willingness-to-pay’ standard of US$50,000 per QALY for a new treatment for major depression. When productivity gains due to clinical recovery were included, the ICER was reduced to US$6667 per QALY. In open-label conditions, TMS provided a net cost saving of US$1123 per QALY when compared with the current standard of care. In the openlabel condition, cost savings increased further when the costs for productivity losses were included in the model (net savings of US$7621). The overall cost benefits of treating MD using TMS were greater in those patients at the earliest levels of treatment resistance in the overall sample.

Conclusion

TMS is a cost-effective treatment for patients who have failed to receive sufficient benefit from initial antidepressant pharmacotherapy. When used at earlier levels of treatment resistance, significant cost savings may be expected relative to the current standard of care.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:3095–3105.

    Article  PubMed  Google Scholar 

  2. Klerman GL, Weissman MM. Increasing rates of depression. JAMA. 1989;261:2229–2235.

    Article  CAS  PubMed  Google Scholar 

  3. Robins LN, Regier DA. Psychiatric Disorders in America: the Epidemiological Catchment Area Study. New York: The Free Press; 1991.

    Google Scholar 

  4. Trivedi MH, Rush AJ, Crismon ML, et al. Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project. Arch Gen Psychiatry. 2004;61:669–680.

    Article  PubMed  Google Scholar 

  5. Khan A, Detke M, Khan SR, Mallinckrodt C. Placebo response and antidepressant clinical trial outcome. J Nerv Ment Dis. 2003;191:211–218.

    Article  PubMed  Google Scholar 

  6. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163:1905–1917.

    Article  PubMed  Google Scholar 

  7. Hirschfeld RM. American health care systems and depression: the past, present, and the future. J Clin Psychiatry. 1998;59(suppl. 20):5–10.

    Google Scholar 

  8. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors Global Burden of Disease Study. Lancet. 1997;349:1436–1442.

    Article  CAS  PubMed  Google Scholar 

  9. Davidson RJ, Pizzagalli D, Nitschke JB, Putnam K. Depression: perspectives from affective neuroscience. Annu Rev Psychol. 2002;53:545–574.

    Article  PubMed  Google Scholar 

  10. Nahas Z, Kozel FA, George MS. Somatic treatments in psychiatry. In: Panksepp J, ed. Textbook of Biological Psychiatry. New York: Wiley; 2003:521–540.

    Chapter  Google Scholar 

  11. Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of the human motor cortex. Lancet. 1985;1:1106–1107.

    Article  CAS  PubMed  Google Scholar 

  12. Nahas Z, Lomarev M, Roberts DR, et al. Unilateral left prefrontal transcranial magnetic stimulation (TMS) produces intensity-dependent bilateral effects as measured by interleaved BOLD fMRI. Biol Psychiatry. 2001;50:712–720.

    Article  CAS  PubMed  Google Scholar 

  13. Eranti S, Mogg A, Pluck G, et al. A randomized, controlled trial with 6-month follow-up of repetitive transcranial magnetic stimulation and electroconvulsive therapy for severe depression. Am J Psychiatry. 2007;164:73–81.

    Article  PubMed  Google Scholar 

  14. O’Reardon JP, Solvason HB, Janicak PG, et al. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007;62:1208–1216.

    Article  PubMed  Google Scholar 

  15. Kozel FA, George MS, Simpson KN. Decision analysis of the cost-effectiveness of repetitive transcranial magnetic stimulation versus electroconvulsive therapy for treatment of nonpsychotic severe depression. CNS Spectr. 2004;9:476–482.

    PubMed  Google Scholar 

  16. Knapp M, Romeo R, Mogg A, et al. Cost-effectiveness of transcranial magnetic stimulation vs. electroconvulsive therapy for severe depression: a multi-centre randomised controlled trial. J Affect Disord. 2008;109:273–285.

    Article  PubMed  Google Scholar 

  17. Avery DH, Isenberg KE, Sampson SM, et al. Transcranial magnetic stimulation in the acute treatment of major depressive disorder: clinical response in an open-label extension trial. J Clin Psychiatry. 2008;69:441–451.

    Article  PubMed  Google Scholar 

  18. Janicak PG, O’Reardon JP, Sampson SM, et al. Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. J Clin Psychiatry. 2008;69:222–232.

    Article  PubMed  Google Scholar 

  19. Ubel PA, Hirth RA, Chernew ME, Fendrick AM. What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med. 2003;163:1637–1641.

    Article  PubMed  Google Scholar 

  20. Cost-effectiveness thresholds. World Health Organization web site. Available at: http://who.imt/choice/costs/CER_thresholds/en/index.html. Accessed June 2008.

  21. World economic and financial surveys. World economic outlook database. International Monetary Fund web site. Available at: www.imf.org. Accessed June 27, 2008.

  22. Sackeim HA. The definition and meaning of treatment-resistant depression. J Clin Psychiatry. 2001;62(suppl. 16):10–17.

    Google Scholar 

  23. Lisanby SH, Husain MM, Rosenquist PB, et al. Daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) in the acute treatment of major depression: clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology. 2008;34:522–534.

    Article  PubMed  Google Scholar 

  24. Healthcare Cost and Utilization Project (HCUP). H-CUP 2004. Available at: www.hcup-us.ahrq.gov. Accessed June 2008.

  25. Greenhalgh J, Knight C, Hind D, Beverley C, Walters S. Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies. Health Technol Assess. 2005;9:1–156, iii-iv.

    CAS  PubMed  Google Scholar 

  26. Croghan TW, Obenchain RL, Crown, WE. What does treatment of depression really cost? Health Aff (Millwood). 1998;17:198–208.

    Article  CAS  Google Scholar 

  27. Greenberg PE, Kessler RC, Birnbaum HG, et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry. 2003;64:1465–1475.

    Article  PubMed  Google Scholar 

  28. Kamlet MS, Paul N, Greenhouse J, et al. Cost utility analysis of maintenance treatment for recurrent depression. Control Clin Trials. 1995;16:17–40.

    Article  CAS  PubMed  Google Scholar 

  29. McLaughlin TP, Eaddy MT, Grudzinski AN. A claims analysis comparing citalopram with sertraline as initial pharmacotherapy for a new episode of depression: impact on depression-related treatment charges. Clin Ther. 2004;26:115–124.

    Article  CAS  PubMed  Google Scholar 

  30. Revicki DA, Brown RE, Palmer W, et al. Modelling the cost effectiveness of antidepressant treatment in primary care. Pharmacoeconomics. 1995;8:524–540.

    Article  CAS  PubMed  Google Scholar 

  31. Greenhalgh J, Knight C, Beverley C, Walters S. Electroconvulsive therapy (ECT) for depressive illness, schizophrenia, catatonia, and mania. Report on behalf of National Institute for Clinical Excellence. Nuffield Institute for Health, University of Leeds, United Kingdom 2006. Available at: www.nice.org.uk/nicemedia/pdf/Final_assessment_reportECT.pdf. Accessed August 23, 2002.

    Google Scholar 

  32. The Red Book — a Guide to Work Incentives. 2006 Red Book. Social Security Online web site. Available at: www.socialsecurity.gov/redbook/. Accessed June 2008.

  33. Inventory of Depressive Symptomatology (IDS) and Quick Inventory of Depressive Symptomatology (QIDS). Available at: http://www.ids-qids.org/. Accessed December 2008.

  34. Grunhaus L, Dannon, PN, Schreiber S, et al. Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: an open study. Biol Psychiatry. 2000;47:314–324.

    Article  CAS  PubMed  Google Scholar 

  35. Nahas Z. Transcranial magnetic stimulation for treating psychiatric conditions: what have we learned so far? Can J Psychiatry. 2008;53:553–554.

    PubMed  Google Scholar 

  36. Sackeim HA, Prudic J, Fuller R, et al. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology. 2007;32:244–254.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical University of South Carolina, 67 President Street, Room 502N, Charleston, SC, 29403, USA

    Kit N. Simpson & Ziad Nahas

  2. Rush University Medical Center, Chicago, Illinois, USA

    Mary Jane Welch

  3. UT Southwestern, Dallas, Texas, USA

    F. Andrew Kozel

  4. Neuronetics, Inc., Malvern, Pennsylvania, USA

    Mark A. Demitrack

Authors
  1. Kit N. Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary Jane Welch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Andrew Kozel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark A. Demitrack
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ziad Nahas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ziad Nahas.

Additional information

An erratum to this article can be found online at http://dx.doi.org/10.1007/s12325-009-0053-2

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Simpson, K.N., Welch, M.J., Kozel, F.A. et al. Cost-effectiveness of transcranial magnetic stimulation in the treatment of major depression: a health economics analysis. Adv Therapy 26, 346–368 (2009). https://doi.org/10.1007/s12325-009-0013-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-009-0013-x

Keywords

search

Navigation