Dec 6, 2019

Cost-Utility Analysis of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Ontario

Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie
Kyle P FitzgibbonDaniel M Blumberger

Abstract

To evaluate the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT), and combining both treatments in a stepped care pathway for patients with treatment-resistant depression (TRD) in Ontario. A cost-utility analysis evaluated the lifetime costs and benefits to society of rTMS and ECT as first-line treatments for TRD using a Markov model, which simulates the costs and health benefits of patients over their lifetime. Health states included acute treatment, maintenance treatment, remission, and severe depression. Treatment efficacy and health utility data were extracted and synthesized from randomized controlled trials and meta-analyses evaluating these techniques. Direct costing data were obtained from national and provincial costing databases. Indirect costs were derived from government records. Scenario, threshold, and probabilistic sensitivity analyses were performed to test robustness of the results. rTMS dominated ECT, as it was less costly and produced better health outcomes, measured in quality-adjusted life years (QALYs), in the base case scenario. rTMS patients gained an average of 0.96 additional QALYs (equivalent to approximately 1 year in perfect health) over t...Continue Reading

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Mentioned in this Paper

Biochemical Pathway
Meta Analysis (Statistical Procedure)
First-Line Therapy
National Area
Patient Care
Controlled Clinical Trials, Randomized
Depressive Disorder, Treatment-Resistant
Transcranial Magnetic Stimulation, Repetitive
Analysis
Electroconvulsive Therapy

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