title: Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.
abstract: BACKGROUND
  Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are conflicting.
  
  
  METHODS
  We conducted a cost-effectiveness analysis comparing ECT alone, rTMS alone and rTMS followed by ECT when rTMS fails under the perspective of the Spanish National Health Service. The analysis is based on a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives over a 12-month period. Data to populate this model were extracted and synthesized from a series of randomized controlled trials and other studies that have compared these techniques on the patient group of interest. We measure effectiveness using quality-adjusted life years (QALYs) and characterize the uncertainty using probabilistic sensitivity analyses.
  
  
  RESULTS
  ECT alone was found to be less costly and more effective than rTMS alone, while the strategy of providing rTMS followed by ECT when rTMS fails is the most expensive and effective option. The incremental cost per QALY gained of this latter strategy was found to be above the reference willingness-to-pay threshold used in these types of studies in Spain and other countries. The probability that ECT alone is the most cost-effective alternative was estimated to be around 70%.
  
  
  CONCLUSIONS
  ECT is likely to be the most cost-effective option in the treatment of resistant severe depression for a willingness to pay of €30,000 per QALY.
authors.affiliation: Departamento de Economía de las Instituciones,Estadística Económica y Econometría,Universidad de la Laguna,Spain.
authors.forename: L
authors.initials: L
authors.lastname: Vallejo-Torres
authors.affiliation: Servicio de Evaluación del Servicio Canario de la Salud (SESCS),Tenerife,Spain.
authors.forename: I
authors.initials: I
authors.lastname: Castilla
authors.affiliation: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC),Spain.
authors.forename: N
authors.initials: N
authors.lastname: González
authors.affiliation: Research Department of Primary Care and Population Health,University College London,UK.
authors.forename: R
authors.initials: R
authors.lastname: Hunter
authors.affiliation: Hospital Universitario de la Princesa,Madrid,Spain.
authors.forename: P
authors.initials: P
authors.lastname: Serrano-Pérez
authors.affiliation: Centro de Investigaciones Biomédicas de Canarias (CIBICAN),Spain.
authors.forename: L
authors.initials: L
authors.lastname: Perestelo-Pérez
mesh_terms: D003131:Combined Modality Therapy / Q000191:economics; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D061218:Depressive Disorder, Treatment-Resistant / Q000191:economics / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000191:economics* / Q000379:methods; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013030:Spain; D050781:Transcranial Magnetic Stimulation / Q000191:economics* / Q000379:methods
keywords: repetitive transcranial magnetic stimulation