title: Cost-effectiveness of transcranial magnetic stimulation vs. electroconvulsive therapy for severe depression: a multi-centre randomised controlled trial.
abstract: BACKGROUND
  Electroconvulsive therapy (ECT) has a long history of use in treating depression. Repetitive transcranial magnetic stimulation (rTMS) has been introduced more recently to the treatment spectrum. Its cost-effectiveness has not been explored.
  
  
  METHODS
  Forty-six right-handed people with severe depressive episodes referred for ECT were randomised to receive either ECT twice weekly or rTMS on consecutive weekdays. Health and other service use were recorded for retrospective periods of 3 months prior to initiation of treatment and during the 6 months following the end of allocated treatment. Costs were calculated for the treatment period and the subsequent 6 months, and comparisons made between groups after adjustment for any baseline differences. Cost-effectiveness analysis was conducted with incremental change on the 17-item Hamilton Rating Scale for Depression (HRSD) as the primary outcome measure, and quality-adjusted life years (based on SF6D-generated utility scores with societal weights) as secondary outcome, cost-effectiveness acceptability curves plotted.
  
  
  RESULTS
  Based on the HRSD scores and other outcome measures, rTMS was not as effective as ECT. The cost of a single session of rTMS was lower than the cost of a session of ECT, but overall there were no treatment cost differences. In the treatment and 6-month follow-up periods combined, health and other service costs were not significantly different between the two groups. Informal care costs were higher for the rTMS group. Total treatment, service and informal care costs were also higher for the rTMS group. The cost-effectiveness acceptability curves indicated a very small probability that decision-makers would view rTMS as more cost-effective than ECT.
  
  
  CONCLUSIONS
  Small sample size, some sample attrition and a relatively short follow-up period of 6 months for a chronic illness. Productivity losses could not be calculated.
  
  
  CONCLUSIONS
  ECT is more cost-effective than rTMS in the treatment of severe depression.
authors.affiliation: Centre for the Economics of Mental Health, King's College London, Institute of Psychiatry, UK. m.knapp@iop.kcl.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Renee
authors.initials: R
authors.lastname: Romeo
authors.forename: Andrew
authors.initials: A
authors.lastname: Mogg
authors.forename: Savitha
authors.initials: S
authors.lastname: Eranti
authors.forename: Graham
authors.initials: G
authors.lastname: Pluck
authors.forename: Rick
authors.initials: R
authors.lastname: Purvis
authors.forename: Richard G
authors.initials: RG
authors.lastname: Brown
authors.forename: Robert
authors.initials: R
authors.lastname: Howard
authors.forename: Michael
authors.initials: M
authors.lastname: Philpot
authors.forename: John
authors.initials: J
authors.lastname: Rothwell
authors.forename: Denzil
authors.initials: D
authors.lastname: Edwards
authors.forename: Declan M
authors.initials: DM
authors.lastname: McLoughlin
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D050781:Transcranial Magnetic Stimulation / Q000191:economics*