Neurostimulation therapies in major depressive disorder: A decision‐analytic model
Autor: | Ying Jiao Zhao, Phern-Chern Tor, Edimansyah Abdin, Monica Teng, Boon Peng Lim, Ai Leng Khoo, Yee Ming Mok |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Cost-Benefit Analysis medicine.medical_treatment behavioral disciplines and activities 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation Electroconvulsive therapy mental disorders medicine Humans Electroconvulsive Therapy Neurostimulation health care economics and organizations Biological Psychiatry Depressive Disorder Major business.industry Analytic model medicine.disease Transcranial Magnetic Stimulation Antidepressive Agents 030227 psychiatry Transcranial magnetic stimulation Psychiatry and Mental health Major depressive disorder Antidepressant Quality-Adjusted Life Years Pshychiatric Mental Health business 030217 neurology & neurosurgery |
Zdroj: | Early Intervention in Psychiatry. 15:1531-1541 |
ISSN: | 1751-7893 1751-7885 |
Popis: | Aim Neurostimulation techniques are effective treatments for major depressive disorders (MDD). However, the optimal sequence of electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) as part of antidepressant treatment algorithm is unclear. We examined the cost-effectiveness of ECT and TMS in MDD. Methods A decision-analytic model was developed to determine total costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) for 10 strategies. Each strategy comprised four treatment lines with ECT and TMS incorporated as second, third, or fourth line. A scenario analysis that explored the cost-effectiveness of maintenance approach by continuing ECT and TMS after acute treatment was performed. Results In the base case, fourth-line TMS after three preceding trials of antidepressants was least costly at US$ 5523 yielding 1.424 QALYs. Compared with this strategy, fourth-line ECT and third-line TMS followed by ECT were cost-effective with ICERs of US$ 7601 per QALY gained and US$ 11 388 per QALY gained, respectively. In the scenario analysis where continuation treatments of ECT and TMS were provided, third-line TMS followed by ECT was cost-effective, with an ICER of US$ 17 198 per QALY gained. Effectiveness of ECT and cost of managing severe depression were influential parameters affecting the cost-effectiveness results. Conclusions In acute treatment of MDD, fourth-line ECT was the most cost-effective strategy. In maintenance treatment, the strategy that incorporated third-line TMS and fourth-line ECT was cost-effective. The overall findings confirmed the value of neurostimulation therapies which should be offered early in the process of managing depression. |
Databáze: | OpenAIRE |
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