title: Comparison between neurostimulation techniques repetitive transcranial magnetic stimulation vs electroconvulsive therapy for the treatment of resistant depression: patient preference and cost-effectiveness.
abstract: OBJECTIVE
  Major depressive disorder (MDD) is a common disorder, widely distributed in the population, and is often associated with severe symptoms and functional impairment. It has been estimated that 30% of MDD patients do not benefit adequately from therapeutic interventions, including pharmacotherapy and psychotherapy. Treatment-resistant depression (TRD) is generally defined as a failure to achieve remission, despite therapeutic interventions.
  
  
  OBJECTIVE
  The most effective treatment alternatives for TRD are hospitalization, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS). Here we compared the clinical effectiveness of ECT and TMS, including success rates, patient responses, side-effect profiles, and financial worthiness.
  
  
  RESULTS
  We found that ECT (P<0.0001) was more effective than TMS (P<0.012) (not statistically significant in group effect) in TRD patients. However, ECT patients reported a higher percentage of side effects (P<0.01) and the TMS treatment scored better in terms of patient preference. The cost benefit of ECT was higher than that of TMS (US$2075 vs US$814). Patient's preferences for treatment could be more intense in the TMS, if the TMS is included in the Health Maintenance Organization's service list.
  
  
  CONCLUSIONS
  We propose that both of these treatment options should be available in psychiatric wards, thus expanding the therapeutic toolkit for TRD.
authors.affiliation: Public Health and Health Systems Management Program, Department of Management, Bar-Ilan University, Ramat Gan.
authors.forename: Racheli
authors.initials: R
authors.lastname: Magnezi
authors.affiliation: Public Health and Health Systems Management Program, Department of Management, Bar-Ilan University, Ramat Gan.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Aminov
authors.affiliation: Beer Yaakov Mental Health Center affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Dikla
authors.initials: D
authors.lastname: Shmuel
authors.affiliation: Public Health and Health Systems Management Program, Department of Management, Bar-Ilan University, Ramat Gan.
authors.forename: Merav
authors.initials: M
authors.lastname: Dreifuss
authors.affiliation: Public Health and Health Systems Management Program, Department of Management, Bar-Ilan University, Ramat Gan; Beer Yaakov Mental Health Center affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Pinhas
authors.initials: P
authors.lastname: Dannon
keywords: ECT; TMS; cost benefit; patient preference; treatment-resistant depression