Hunter, RM; (2014) Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment–resistant severe depression: a decision model. Psychological Medicine 10.1017/S0033291714002554.

Preview

PDF (Creative Commons Attribution Licence) Cost_effectiveness.pdf Download (288kB)

Abstract

Background: Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are conflicting. Methods: We conduct a cost-effectiveness analysis comparing ECT alone, rTMS alone and rTMS followed by ECT when rTMS fails under the perspective of the Spanish National Health Service. The analysis is based on a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives over a 12 month period. Data to populate this model were extracted and synthesised from a series of randomised controlled trials and other studies that have compared these techniques on the patient group of interest. We measure effectiveness using Quality-Adjusted Life Years (QALY) and characterise the uncertainty using probabilistic sensitivity analyses. Results: ECT alone is found to be less costly and more effective than rTMS alone, while the strategy of providing rTMS followed by ECT when rTMS fails is the most expensive and effective option. The incremental cost per QALY gained of this latter strategy is found to be above the reference willingness to pay threshold used in these types of studies in Spain and other countries. The probability that ECT alone is the most cost-effective alternative was estimated to be around 70%. Conclusions: ECT is likely to be the most cost-effective option in the treatment of resistant severe depression for a willingness to pay of 30,000€ per QALY.

Download activity - last month

Export as XMLCSVJSON

Download activity - last 12 months

Export as CSVXMLJSON

Downloads by country - last 12 months

Export as JSONXMLCSV

Archive Staff Only

View Item