Transcranial Magnetic Stimulation vs. Traditional Pharmacotherapy for Major Depressive Disorder
Author: Mark Gold, MD
Repetitive transcranial magnetic stimulation (rTMS) is a novel, non-invasive method of activating neural signals through the use of strong, time-varying electromagnetic fields. rTMS is primarily used for patients with treatment-resistant depression. As its reputation has grown, so has its demand. But in the world of health economics and Return on Investment (ROI) ratios, is rTMS a viable option for the millions of people suffering from depression? To date, no such analysis has examined the cost-effectiveness of rTMS as a first line or at least an earlier treatment option over a patient’s lifetime.
To investigate this question, Voight and Leuchter (2017) used Markov simulation modeling to analyze direct costs and quality adjusted life years (QALYs) of rTMS versus medication therapy in patients with newly diagnosed Major Depressive Disorder (MDD) who were age 20-59 and had not improved after a single pharmacotherapy trial. Response and remission rates, quality of life outcomes and life expectancy were culled from the scientific literature. The baseline for treatment costs was derived from federal Medicare reimbursement data. Additional baseline data included QALYs, assessment of superiority, analysis of instrument sensitivity, and lastly, a discount rate of 3% was applied.
The results of this complicated health/economic analysis revealed the superiority of rTMS over currently available pharmacotherapy across the lifespan of adults with MDD, assuming the current costs of treatment remain stable.
Why Does This Matter?
The mortality rate for untreated or undertreated depression is between 15 and 20 percent and growing as addictive disease and chronic pain are increasing, and are bi-directionally associated with MDD.
During a recent visit to China, I heard the simple but inescapable logic of TMS therapy as a first line treatment for depression. Simply stated, the Chinese doctors assert, “Why treat every cell in the body when only the brain causes depression?” So, not only is TMS/rTMS safe and effective and approved by the FDA for refractory depression, but it is also life-saving and life giving. TMS has a very high success rate, and these economic data reveal important cost benefits over other less effective treatments. It is really a no brainer.
Voigt J, Carpenter L, Leuchter A. Cost effectiveness analysis comparing repetitive transcranial magnetic stimulation to antidepressant medications after a first treatment failure for major depressive disorder in newly diagnosed patients – A lifetime analysis. PloS one. 2017;12(10): e0186950.