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Wednesday, May 21, 2014

TMS Is Cost-Effective for Treatment Resistant Depression

TMS Is Cost-Effective for Treatment Resistant Depression

by Lauren LeBano

NEW YORK—Transcranial magnetic stimulation (TMS) is a cost-effective option for treating depression in patients who do not benefit from initial antidepressant medication, according to a study presented at the 167th meeting of the American Psychiatric Association. 

In 2008, the U.S. Food and Drug Administration approved TMS for treatment of major depressive disorder. The noninvasive therapy delivers focused magnetic field pulses that stimulate areas of the brain that play a role in mood regulation. 

To assess the economic value of TMS, researchers used a pseudo-randomized comparison of 306 patients treated with TMS (Neurostar TMS Therapy System) and matched patients who were enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. 

The analysis involved comparing weekly failure and improvement rates among the populations as well as classifying clinical outcomes into four depression health states based on QIDS-SR score. 

Using a Markov model, investigators calculated cost and quality-adjusted life years (QALY) expected for each treatment, with the assumption of an average of 28.7 TMS treatments during the acute phase and six treatments during the taper phase. Patients receiving antidepressant treatment were assumed to take a single antidepressant drug for six weeks that could be augmented if they did not remit. 

The Markov model used a two-year time horizon to calculate cost per incremental QALY of TMS compared with antidepressant medications. Reimbursed costs of TMS were estimated at $181 per treatment. 

According to the model, TMS had a mean annual cost of $11,886, compared with a cost of $10,888 for standard antidepressant treatment. 

In addition, the Incremental Cost-Effectiveness Ratio for TMS was $36,383, which is less than the “willingness-to-pay” standard of $50,000. 

Lead author Mark A. Demitrack, MD, commented that the efficacy and safety of TMS contribute to its economic value, even though it costs more in the short term. “Over time, the durability of the benefit of TMS is much better than drug therapy. People are staying well, and they’re not dropping out because of side effects,” he told Psych Congress Network.

He added, “Since depression is a chronic illness, it’s much more important to look not just at the six weeks of benefit. Keeping people well over the long term is the real trick.”  

—Lauren LeBano 


“Health Economics Comparison of TMS and Antidepressant Drugs in the Treatment of Major Depression.” Abstract presented at the American Psychiatric Association Meeting. May 5, 2014

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