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. 2017 Oct 26;12(10):e0186950.
doi: 10.1371/journal.pone.0186950. eCollection 2017.

Cost effectiveness analysis comparing repetitive transcranial magnetic stimulation to antidepressant medications after a first treatment failure for major depressive disorder in newly diagnosed patients - A lifetime analysis

Jeffrey Voigt  1 , Linda Carpenter  2 , Andrew Leuchter  3
Affiliations

Cost effectiveness analysis comparing repetitive transcranial magnetic stimulation to antidepressant medications after a first treatment failure for major depressive disorder in newly diagnosed patients - A lifetime analysis

Jeffrey Voigt et al. PLoS One. .

Abstract

Objective: Repetitive Transcranial Magnetic Stimulation (rTMS) commonly is used for the treatment of Major Depressive Disorder (MDD) after patients have failed to benefit from trials of multiple antidepressant medications. No analysis to date has examined the cost-effectiveness of rTMS used earlier in the course of treatment and over a patients' lifetime.

Methods: We used lifetime Markov simulation modeling to compare the direct costs and quality adjusted life years (QALYs) of rTMS and medication therapy in patients with newly diagnosed MDD (ages 20-59) who had failed to benefit from one pharmacotherapy trial. Patients' life expectancies, rates of response and remission, and quality of life outcomes were derived from the literature, and treatment costs were based upon published Medicare reimbursement data. Baseline costs, aggregate per year quality of life assessments (QALYs), Monte Carlo simulation, tornado analysis, assessment of dominance, and one way sensitivity analysis were also performed. The discount rate applied was 3%.

Results: Lifetime direct treatment costs, and QALYs identified rTMS as the dominant therapy compared to antidepressant medications (i.e., lower costs with better outcomes) in all age ranges, with costs/improved QALYs ranging from $2,952/0.32 (older patients) to $11,140/0.43 (younger patients). One-way sensitivity analysis demonstrated that the model was most sensitive to the input variables of cost per rTMS session, monthly prescription drug cost, and the number of rTMS sessions per year.

Conclusion: rTMS was identified as the dominant therapy compared to antidepressant medication trials over the life of the patient across the lifespan of adults with MDD, given current costs of treatment. These models support the use of rTMS after a single failed antidepressant medication trial versus further attempts at medication treatment in adults with MDD.

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Conflict of interest statement

Competing Interests: Jeff Voigt is a reimbursement consultant for an rTMS company. Linda Carpenter, MD is a clinical advisor for rTMS companies. Andrew Leuchter, MD is a clinical advisor for rTMS companies. The funder (Magstim) provided an unrestricted grant to Medical Device Consultants of Ridgewood (commercial company) for the research, analysis, and preparation of the manuscript. The funder did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. Linda Carpenter, MD, has received consulting income from Magstim, Inc (<$5,000/year). Additionally, Dr. Carpenter has received clinical trial research support from Neuronetics, NeoSync, and Jannssen; and equipment support from NeoSync and Neuronetics. The commercial affiliation as noted in the prior paragraph does not alter our adherence to all PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. rTMS Markov model.
See this image and copyright information in PMC

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References

    1. Magstim rTMS. Available from: https://www.magstim.com/clinical-area/rtms-for-major-depressive-disorder... Cited 28 June 2017.
    1. Brainsway Deep TMS therapy. Available from: http://www.brainsway.com/us Cited 6 September 2016.
    1. Magventure MagVita TMS therapy.Available from: http://www.magventure.com/en-gb/FDA-cleared-TMS-depression-treatment Cited 6 September 2016.
    1. Neuronetics Neurostar TMS therapy. Available from: http://www.neuronetics.com/products-services/system/ Cited 7 September 2016.
    1. Neurosoft TMS therapy. Available from: https://www.accessdata.fda.gov/cdrh_docs/pdf16/K160309.pdf Cited 31 May 2017.

Substances

Grants and funding

The funder (Magstim) provided an unrestricted grant to Medical Device Consultants of Ridgewood (commercial company) for the research, analysis, and preparation of the manuscript. The funder did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. Linda Carpenter, MD, has received consulting income from Magstim, Inc (<$5,000/year). Additionally, Dr. Carpenter has received clinical trial research support from Neuronetics, NeoSync, and Jannssen; and equipment support from NeoSync and Neuronetics.