Hendriks Lauren, Mihalopoulos Cathrine, Le Long Khanh-Dao, Loo Colleen, Chatterton Mary Lou
Deakin University, Geelong, Victoria, Deakin Health Economics, Institute for Health Transformation, Australia.
University of New South Wales.
Eur Psychiatry. 2022 Mar 30;65(1):1-32. doi: 10.1192/j.eurpsy.2022.13.
This research evaluates the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) as add-on therapy to standard care for adults with schizophrenia from an Australian health system perspective.
A Markov model estimated costs in 2021 Australian dollars and Disability-Adjusted Life-Years (DALYs) averted with rTMS added to standard care compared to standard care alone over 12-months for adults aged 25–65 years with hallucinations in schizophrenia refractory to other therapies. rTMS effect size was sourced from a meta-analysis and converted to a relative risk using the Cochrane conversion method. Probabilistic sensitivity analysis evaluated uncertainty in effect size and disability weights. One-way sensitivity analyses varied rTMS session cost and effectiveness, time horizon and inpatient costs.
The base-case average incremental cost-effectiveness ratio (ICER) was $87,310/DALY averted (95% UI: $10,157–$97,877). Reducing rTMS session cost to $100 lowered the ICER to $9,127/DALY (95% UI: Dominant–$50,699). A 4-year time horizon resulted in rTMS being less costly and more effective (Dominant) than standard care. Decreasing the 3-month probability of relapse with rTMS to 4.6% resulted in a 71% probability of rTMS being cost-effective.
Using a threshold of $50,000/ DALY averted, rTMS as add-on therapy to standard care for the treatment of refractory hallucinations in schizophrenia would not be considered a cost-effective treatment option compared to standard care alone. However, given the refractory nature of this condition and the relatively small size of this population, it may be reasonable for decision-makers to adopt a higher ICER threshold.
本研究从澳大利亚卫生系统的角度评估重复经颅磁刺激（rTMS）作为成年精神分裂症患者标准治疗附加疗法的成本效益。
采用马尔可夫模型估算了2021年澳元成本以及与仅采用标准治疗相比，为25至65岁对其他疗法难治的精神分裂症幻觉患者在12个月内将rTMS添加到标准治疗中所避免的伤残调整生命年（DALYs）。rTMS效应量来源于一项荟萃分析，并使用Cochrane转换方法转换为相对风险。概率敏感性分析评估了效应量和残疾权重的不确定性。单向敏感性分析改变了rTMS治疗费用和效果、时间范围和住院费用。
基础案例平均增量成本效益比（ICER）为每避免一个DALY 87,310澳元（95%不确定区间：10,157 - 97,877澳元）。将rTMS治疗费用降至100澳元可使ICER降至每DALY 9,127澳元（95%不确定区间：占优 - 50,699澳元）。4年的时间范围导致rTMS比标准治疗成本更低且更有效（占优）。将rTMS治疗后3个月复发概率降至4.6%，rTMS具有成本效益的概率为71%。
以每避免一个DALY 50,000澳元为阈值，与仅采用标准治疗相比，rTMS作为成年精神分裂症难治性幻觉标准治疗的附加疗法不被认为是具有成本效益的治疗选择。然而，鉴于这种疾病的难治性以及该人群规模相对较小，决策者采用更高的ICER阈值可能是合理的。
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