Cost-Effectiveness of Repetitive Transcranial Magnetic Stimulation versus Antidepressant Therapy for Treatment-Resistant Depression

• Published in: Value in health 2015-07, Vol.18 (5), p.597-604
• Main Authors: Nguyen, Kim-Huong, PhD, Gordon, Louisa G., PhD
• Format: Article
• Language: English
• Subjects: antidepressant; Antidepressive Agents - economics; Antidepressive Agents - therapeutic use; Computer Simulation; cost effectiveness analysis; Cost Savings; Cost-Benefit Analysis; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - economics; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Depressive Disorder, Treatment-Resistant - diagnosis; Depressive Disorder, Treatment-Resistant - economics; Depressive Disorder, Treatment-Resistant - psychology; Depressive Disorder, Treatment-Resistant - therapy; Drug Costs; economic evaluation; Humans; Internal Medicine; Markov Chains; Markov model; microsimulation; Models, Economic; Quality-Adjusted Life Years; repetitive transcranial magnetic stimulation; Time Factors; Transcranial Magnetic Stimulation - economics; Treatment Outcome
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2015.04.004

Abstract Background Repetitive transcranial magnetic stimulation (rTMS) therapy is a clinically safe, noninvasive, nonsystemic treatment for major depressive disorder. Objective We evaluated the cost-effectiveness 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.