Cost-effectiveness of transcranial magnetic stimulation vs. electroconvulsive therapy for severe depression: A multi-centre randomised controlled trial

Knapp, Martín; Romeo, Renée; Mogg, Andrew; Eranti, Savitha; Pluck, Graham; Purvis, Richard; Brown, Richard G.; Howard, Robert; Philpot, Michael; Rothwell, John C.; Edwards, David I.; McLoughlin, Declan M.

doi:10.1016/j.jad.2008.01.001

Cited by 42 publications

(43 citation statements)

References 17 publications

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“…13 TMS has been shown to be safe and effective in the treatment of patients with major depression. [13][14][15][16][17][18][19][20][21][22][23] Two reports have already discussed the health economic impact of TMS in patients with depression. 15,16 Both analyses were conducted using either historical estimates of TMS efficacy, 15 or based on the results of a limited, fixed-dose treatment paradigm conducted in a small sample.…”

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confidence: 99%

“…[13][14][15][16][17][18][19][20][21][22][23] Two reports have already discussed the health economic impact of TMS in patients with depression. 15,16 Both analyses were conducted using either historical estimates of TMS efficacy, 15 or based on the results of a limited, fixed-dose treatment paradigm conducted in a small sample. 13,16 Since those reports, the results of the first large, multisite, randomized, controlled study of TMS used as monotherapy in patients with pharmacotherapy-resistant depression have been published.…”

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confidence: 99%

“…15,16 Both analyses were conducted using either historical estimates of TMS efficacy, 15 or based on the results of a limited, fixed-dose treatment paradigm conducted in a small sample. 13,16 Since those reports, the results of the first large, multisite, randomized, controlled study of TMS used as monotherapy in patients with pharmacotherapy-resistant depression have been published. 17 This clinical development program also included two open-label extension studies that provided information on acute efficacy 17 is generally considered highly cost-effective.…”

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confidence: 99%

“…In that report, ECT alone compared with TMS alone was predicted to add US$460,031 per QALY gained. The strategy of treating with TMS first and then referring nonresponders to ECT revealed that this strategy compared with ECT alone showed cost savings and an increase of US$1538 QALYs gained.In contrast with the conclusions from the Kozel report, Knapp et al16 recently published a cost-effectiveness study that compared ECT and TMS based on a clinical trial13 where patients were randomized to receive either ECT twice weekly in an adjustable design or TMS on consecutive weekdays at a fixed dose and for a fixed duration of 3 weeks. Costs were calculated for the treatment period and for the subsequent 6 months, and comparisons made between groups after adjustment for any baseline differences.…”

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Cost-effectiveness of transcranial magnetic stimulation in the treatment of major depression: a health economics analysis

et al. 2009

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Cost-effectiveness of transcranial magnetic stimulation in the treatment of major depression: a health economics analysis

et al. 2009

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“…The U.S. Food and Drug Administration (FDA) approved the Neurostar TMS device for use in the management of TRMD in 2008 [9]. TMS costs are typically 30% to 50% less than costs associated with ECT [10]. A course of TMS typically is composed of 20-30 outpatient sessions that last approximately one hour and are schedule in the outpatient setting five days per week.…”

Section: Transcranial Magnetic Stimulationmentioning

confidence: 99%

Expanding the Nurse Practitioner Role in Treatment Resistant Major Depression

Svensson¹,

Miller²,

Hurd³

2016

J Hosp Med Manage

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providing ECT, TMS, and KIT related services. All participants reported confidence in their professional self-efficacy with these procedures to independently provide protocol driven services with minimal ongoing supervision with a consulting psychiatrist experienced with these procedures. Following completion of the CE training, this cohort of NP participants participated in 43 patient encounters involving the provision of ECT, TMS and KIT related services over a 60-day follow-up period. This 60-day follow-up period was noted for the absence of adverse and untoward events, patient satisfaction was routinely in the 'satisfied' to 'fully satisfied' range, and clinical outcomes for those patients completing a course of treatment were reported as efficacious for 90% of ECT cases, 80% of KIT cases and 70% of TMS cases. These results are consistent with typical outcomes for psychiatrist provided services at these three clinical sites.

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EFFICACY AND ACCEPTABILITY OF HIGH FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) VERSUS ELECTROCONVULSIVE THERAPY (ECT) FOR MAJOR DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS

2013

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Clinical trials comparing the efficacy and acceptability of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) and electroconvulsive therapy (ECT) for treating major depression (MD) have yielded conflicting results. As this may have been the result of limited statistical power, we have carried out this meta-analysis to examine this issue. We searched the literature for randomized trials on head-to-head comparisons between HF-rTMS and ECT from January 1995 through September 2012 using MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and SCOPUS. The main outcome measures were remission rates, pre-post changes in depression ratings, as well as overall dropout rates at study end. We used a random-effects model, Odds Ratios (OR), Number Needed to Treat (NNT), and Hedges' g effect sizes. Data were obtained from 7 randomized trials, totalling 294 subjects with MD. After an average of 15.2 HF-rTMS and 8.2 ECT sessions, 33.6% (38/113) and 52% (53/102) of subjects were classified as remitters (OR = 0.46; p = 0.04), respectively. The associated NNT for remission was 6 and favoured ECT. Also, reduction of depressive symptomatology was significantly more pronounced in the ECT group (Hedges' g = -0.93; p = 0.007). No differences on dropout rates for HF-rTMS and ECT groups were found. In conclusion, ECT seems to be more effective than HF-rTMS for treating MD, although they did not differ in terms of dropout rates. Nevertheless, future comparative trials with larger sample sizes and better matching at baseline, longer follow-ups and more intense stimulation protocols are warranted.

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Cost-effectiveness of transcranial magnetic stimulation vs. electroconvulsive therapy for severe depression: A multi-centre randomised controlled trial

Cited by 42 publications

References 17 publications

Cost-effectiveness of transcranial magnetic stimulation in the treatment of major depression: a health economics analysis

Cost-effectiveness of transcranial magnetic stimulation in the treatment of major depression: a health economics analysis

Expanding the Nurse Practitioner Role in Treatment Resistant Major Depression

EFFICACY AND ACCEPTABILITY OF HIGH FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) VERSUS ELECTROCONVULSIVE THERAPY (ECT) FOR MAJOR DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS

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