Implementation of intermittent theta burst stimulation compared to conventional repetitive transcranial magnetic stimulation in patients with treatment resistant depression: A cost analysis


Autoři: Andrew B. Mendlowitz aff001;  Alaa Shanbour aff004;  Jonathan Downar aff004;  Fidel Vila-Rodriguez aff006;  Zafiris J. Daskalakis aff001;  Wanrudee Isaranuwatchai aff002;  Daniel M. Blumberger aff001
Působiště autorů: Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada aff001;  Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada aff002;  Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada aff003;  Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada aff004;  MRI-Guided rTMS Clinic and Krembil Research Institute, University Health Network, Toronto, ON, Canada aff005;  Non-Invasive Neurostimulation Therapies (NINET) Laboratory, University of British Columbia Hospital, Vancouver, BC, Canada aff006;  Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada aff007;  The Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada aff008
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222546

Souhrn

Background

Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment for depression that is increasingly implemented in healthcare systems across the world. A new form of rTMS called intermittent theta burst stimulation (iTBS) can be delivered in 3 min and has demonstrated comparable effectiveness to the conventional 37.5 min 10Hz rTMS protocol in patients with depression.

Objectives

To compare the direct treatment costs per course and per remission for iTBS compared to 10Hz rTMS treatment in depression.

Methods

We conducted a cost analysis from a healthcare system perspective using patient-level data from a large randomized non-inferiority trial (THREE-D). Depressed adults 18 to 65 received either 10Hz rTMS or iTBS treatment. Treatment costs were calculated using direct healthcare costs associated with equipment, coils, physician assessments and technician time over the course of treatment. Cost per remission was estimated using the proportion of patients achieving remission following treatment. Deterministic sensitivity analyses and non-parametric bootstrapping was used to estimate uncertainty.

Results

From a healthcare system perspective, the average cost per patient was USD$1,108 (SD 166) for a course of iTBS and $1,844 (SD 304) for 10Hz rTMS, with an incremental net savings of $735 (95% CI 688 to 783). The average cost per remission was $3,695 (SD 552) for iTBS and $6,146 (SD 1,015) for 10Hz rTMS, with an average incremental net savings of $2,451 (95% CI 2,293 to 2,610).

Conclusions

The shorter session durations and treatment capacity increase associated with 3 min iTBS translate into significant cost-savings per patient and per remission when compared to 10Hz rTMS.

Klíčová slova:

Research and analysis methods – Bioassays and physiological analysis – Electrophysiological techniques – Brain electrophysiology – Transcranial stimulation – Transcranial magnetic stimulation – Biology and life sciences – Physiology – Electrophysiology – Neurophysiology – Neuroscience – Brain mapping – Medicine and health sciences – Pharmaceutics – Drug therapy – Mental health and psychiatry – Mood disorders – Depression – Health care – Health care providers – Medical doctors – Physicians – Pharmacology – Drugs – Antidepressants – Engineering and technology – Equipment – Science policy – Science and technology workforce – Careers in research – People and places – Population groupings – Professions – Technicians – Medical personnel – Geographical locations – North America – United States


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2019 Číslo 9
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