title: Economic evaluation of resistant major depressive disorder treatment in Iranian population: a comparison between repetitive Transcranial Magnetic Stimulation with electroconvulsive.
abstract: BACKGROUND
  It is estimated that major depression disorders constitute 8.2% of years lived with disability (YLDs) globally. The repetitive Transcranial Magnetic Stimulation (rTMS) and Electroconvulsive Therapy (ECT) are two relative common interventions to treat major depressive disorders, especially for treatment resistant depression. In this study the cost- effectiveness and cost-utility of rTMS were compared with ECT in Iranian population suffering from major depressive disorder using a decision tree model.
  
  
  METHODS
  A decision tree model conducted to compare the cost-effectiveness ratio of rTMS with ECT in a health system prospective and 7 months' time horizon. The outcome variables were: response rate, remission rate and quality-adjusted life-years (QALYs) of the rTMS and ECT as primary and secondary outcomes extracted from systematic reviews and randomized control trials. The costs were also calculated through a field study in one clinic and one hospital; the direct costs have only been considered.
  
  
  RESULTS
  The total cost for rTMS and ECTstrategieswere11015000Rials (373US$) and 11742700 Rials (397.7US$), respectively. Also the rTMS/ECT ratio of costs per improved patients was 1194410Rials (40.5 US$); the ratio for costs per QALYs utility was 21017139 Rials (711.72 US$). The incremental cost- effectiveness ratio of rTMS versus ECT was 1194410 Rials (40.44 US$) after treatment and maintenance courses.
  
  
  CONCLUSIONS
  Given the current prevalence of depressive disorders in Iranian population, the ECT is more cost-effective than TMS. The sensitivity analysis showed that if the prevalence of major depressive disorders declines to below 5% or the costs of rTMS decrease (rTMS provided by public sector), then the rTMS becomes more cost-effective compared with ECT. However, efficacy of rTMS depends on the frequency of pulsed magnetic field, the location of rTMS on the head, the number of therapeutic sessions and the length of each session.
authors.affiliation: PhD of Health Economics, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. hesambs82@gmail.com .
authors.forename: Hesam
authors.initials: H
authors.lastname: Ghiasvand
authors.affiliation: MSc in Health Technology Assessment, Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. moradijoo@gmail.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Moradi-Joo
authors.affiliation: PhD of Health Policy and Management, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. na_abolhassani@yahoo.com.
authors.forename: Nazanin
authors.initials: N
authors.lastname: Abolhassani
authors.affiliation: PhD of Health Policy, Assistant Professor, Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. ravaghi.h@iums.ac.ir.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ravaghi
authors.affiliation: Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. rayegani@sbmu.ac.ir .
authors.forename: Seyed Mansoor
authors.initials: SM
authors.lastname: Raygani
authors.affiliation: PhD student in Psychology, Ferdowsi University of Mashhad, Faculty of Psychology and Educational Sciences, Mashhad, Iran. sahar_mohabatbahar@yahoo.com .
authors.forename: Sahar
authors.initials: S
authors.lastname: Mohabbat-Bahar
keywords: Decision tree; Electroconvulsive Therapy; Major Depressive disorders; repetitive Transcranial Magnetic Stimulation