title: Decision analysis of the cost-effectiveness of repetitive transcranial magnetic stimulation versus electroconvulsive therapy for treatment of nonpsychotic severe depression.
abstract: BACKGROUND
  Repetitive transcranial magnetic stimulation (rTMS) is a new treatment with promise for resistant depression.
  
  
  OBJECTIVE
  We tested the economic feasibility of this new method compared with electroconvulsive therapy (ECT).
  
  
  METHODS
  An economic decision analysis was used to compare the costs of three different treatment strategies for nonpsychotic severe depression. The strategies were: ECT alone; rTMS alone; and rTMS followed by ECT for nonresponders (rTMS-to-ECT). We calculated 12-month costs and quality adjusted life years (QALYs) for the three treatment options for all nonpsychotic, severely depressed United States patients who would have otherwise undergone ECT. A sensitivity analysis was performed to test the degree of change in outcome with various parameter changes.
  
  
  RESULTS
  The additional cost of using ECT alone compared with rTMS alone was 460,031 US dollars per quality adjusted year of life gained. For ECT versus rTMS-to-ECT, there was both an increased cost and a loss of 1,538 QALYs with ECT alone. The sensitivity analysis revealed the model to be robust with various parameter changes.
  
  
  CONCLUSIONS
  If rTMS were to be made widely available clinically in the US, it would offer a substantial economic benefit over ECT in treating resistant depression. Using rTMS-to-ECT offers not only an economic advantage but also an increase in QALYs. This analysis suggests that rTMS would be a cost-effective treatment for depression compared with the current option of ECT alone.
authors.affiliation: Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, USA. kozelfa@musc.edu
authors.forename: F Andrew
authors.initials: FA
authors.lastname: Kozel
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
mesh_terms: D003362:Cost-Benefit Analysis; D003657:Decision Making; D003865:Major Depressive Disorder / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000191:economics* / Q000295:instrumentation / Q000706:statistics & numerical data; D055590:Electromagnetic Phenomena / Q000191:economics* / Q000295:instrumentation / Q000706:statistics & numerical data; D006801:Humans; D010507:Periodicity; D012720:Severity of Illness Index