Medical University of South Carolina, 67 President Street, Room 502N, Charleston, SC, 29403, USA.
Adv Ther. 2009 Mar;26(3):346-68. doi: 10.1007/s12325-009-0013-x. Epub 2009 Mar 28.
INTRODUCTION: Transcranial magnetic stimulation (TMS) is a novel antidepressant therapy shown to be effective and safe in pharmacotherapy-resistant major depression. The incremental cost-effectiveness and the direct cost burden compared with sham treatment were estimated, and compared with the current standard of care. METHODS: Healthcare resource utilization data were collected during a multicenter study (n=301) and a decision analysis was used to stratify the 9-week treatment outcomes. A Markov model with an acute-outcome severity-based risk of relapse was used to estimate the illness course over a full year of treatment follow-up. These model estimates were also compared to best estimates of outcomes and costs of pharmacotherapy treatment, using the published STAR(*)D outcomes. The cost-effectiveness of TMS was described using an incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained and on a direct cost per patient basis across a varying range of assumptions. The model's sensitivities to costs due to losses in work productivity and to caregiver time were also examined. RESULTS: Compared with sham treatment and at a cost of US$300 per treatment session, TMS provides an ICER of US$34,999 per QALY, which is less than the "willingness-to-pay' standard of US$50,000 per QALY for a new treatment for major depression. When productivity gains due to clinical recovery were included, the ICER was reduced to US$6667 per QALY. In open-label conditions, TMS provided a net cost saving of US$1123 per QALY when compared with the current standard of care. In the openlabel condition, cost savings increased further when the costs for productivity losses were included in the model (net savings of US$7621). The overall cost benefits of treating MD using TMS were greater in those patients at the earliest levels of treatment resistance in the overall sample. CONCLUSION: TMS is a cost-effective treatment for patients who have failed to receive sufficient benefit from initial antidepressant pharmacotherapy. When used at earlier levels of treatment resistance, significant cost savings may be expected relative to the current standard of care.
简介：经颅磁刺激（TMS）是一种新型抗抑郁疗法，已被证明对药物治疗抵抗性重度抑郁症有效且安全。本研究旨在评估与假刺激相比 TMS 的增量成本效益和直接成本负担，并与当前的标准护理进行比较。 方法：在一项多中心研究（n=301）中收集了医疗资源利用数据，并使用决策分析对 9 周的治疗结果进行分层。采用基于急性结局严重程度的复发风险的马尔可夫模型来估计整个治疗随访期 1 年的疾病过程。还使用发表的 STAR(*)D 结果，将这些模型估计与药物治疗的最佳估计结果和成本进行比较。使用增量成本效益比（ICER）每获得一个质量调整生命年（QALY）和每位患者的直接成本来描述 TMS 的成本效益，在不同的假设范围内进行。还检查了模型对因工作生产力损失和护理人员时间而导致的成本的敏感性。 结果：与假刺激相比，TMS 的治疗费用为每次 300 美元，其每 QALY 的增量成本效益比（ICER）为 34999 美元，低于新的重度抑郁症治疗方法 50000 美元/ QALY 的“意愿支付”标准。当包括因临床康复而带来的生产力收益时，ICER 降低至 6667 美元/ QALY。在开放标签条件下，与当前的标准护理相比，TMS 的每 QALY 净成本节约为 1123 美元。在开放标签条件下，当模型中包括生产力损失成本时，成本节约进一步增加（净节约 7621 美元）。在整个样本中，在最初的抗抑郁药物治疗耐药水平较高的患者中，使用 TMS 治疗 MD 的总体成本效益更高。 结论：对于初始抗抑郁药物治疗未能充分获益的患者，TMS 是一种具有成本效益的治疗方法。在更早的治疗耐药水平使用 TMS，与当前的标准护理相比，可能会带来显著的成本节约。
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