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dc.contributor.authorNguyen, Kim-Huong
dc.contributor.authorGordon, Louisa G
dc.date.accessioned2017-06-02T00:32:08Z
dc.date.available2017-06-02T00:32:08Z
dc.date.issued2015
dc.identifier.issn1098-3015
dc.identifier.doi10.1016/j.jval.2015.04.004
dc.identifier.urihttp://hdl.handle.net/10072/101410
dc.description.abstractBackground: Repetitive transcranial magnetic stimulation (rTMS) therapy is a clinically safe, noninvasive, nonsystemic treatment for major depressive disorder. Objective: We evaluated the cost-effectiveness of rTMS versus pharmacotherapy for the treatment of patients with major depressive disorder who have failed at least two adequate courses of antidepressant medications. Methods: A 3-year Markov microsimulation model with 2-monthly cycles was used to compare the costs and quality-adjusted life-years (QALYs) of rTMS and a mix of antidepressant medications (including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclics, noradrenergic and specific serotonergic antidepressants, and monoamine oxidase inhibitors). The model synthesized data sourced from published literature, national cost reports, and expert opinions. Incremental cost-utility ratios were calculated, and uncertainty of the results was assessed using univariate and multivariate probabilistic sensitivity analyses. Results: Compared with pharmacotherapy, rTMS is a dominant/cost-effective alternative for patients with treatment-resistant depressive disorder. The model predicted that QALYs gained with rTMS were higher than those gained with antidepressant medications (1.25 vs. 1.18 QALYs) while costs were slightly less (AU $31,003 vs. AU $31,190). In the Australian context, at the willingness-to-pay threshold of AU $50,000 per QALY gain, the probability that rTMS was cost-effective was 73%. Sensitivity analyses confirmed the superiority of rTMS in terms of value for money compared with antidepressant medications. Conclusions: Although both pharmacotherapy and rTMS are clinically effective treatments for major depressive disorder, rTMS is shown to outperform antidepressants in terms of cost-effectiveness for patients who have failed at least two adequate courses of antidepressant medications.
dc.description.peerreviewedYes
dc.languageEnglish
dc.publisherElsevier
dc.relation.ispartofpagefrom597
dc.relation.ispartofpageto604
dc.relation.ispartofissue5
dc.relation.ispartofjournalValue in Health
dc.relation.ispartofvolume18
dc.subject.fieldofresearchPublic Health and Health Services not elsewhere classified
dc.subject.fieldofresearchPublic Health and Health Services
dc.subject.fieldofresearchApplied Economics
dc.subject.fieldofresearchcode111799
dc.subject.fieldofresearchcode1117
dc.subject.fieldofresearchcode1402
dc.titleCost-Effectiveness of Repetitive Transcranial Magnetic Stimulation versus Antidepressant Therapy for Treatment-Resistant Depression
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
dcterms.licensehttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.description.versionPost-print
gro.facultyGriffith Health, School of Medicine
gro.rights.copyright© 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (http://creativecommons.org/licenses/by-nc-nd/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.
gro.hasfulltextFull Text
gro.griffith.authorGordon, Louisa
gro.griffith.authorNguyen, Kim-Huong


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