Transcranial magnetic stimulation (TMS) is a cost-effective treatment option for patients with refractory major depressive disorder (MDD), according to a new economic analysis. According to Kit Simpson, professor of health and science research at the California Medical School in Charleston, “Its cost-effectiveness is primarily because it is not much more expensive compared to medications, but has significantly improved outcomes compared to medications.” The results of the study were presented at the 2014 American Psychiatric Association Annual Meeting (APA 2014). The analysis focused on the treatment effects of the NeuroStar TMS system. It is a noninvasive treatment that delivers MRI-enhanced pulsed magnetic fields that generate electrical currents in localized areas of the cerebral cortex. It was approved by the U.S. Food and Drug Administration (FDA) in October 2008 for the treatment of drug-resistant major depressive episodes. Previous studies have shown that TMS provides long-lasting and sustained relief from drug-resistant major depressive episodes and significantly improves patients’ quality of life (QoL) and functional status. Dr. Simpson and colleagues conducted a cost-utility analysis using data from previous studies using the NeuroStar TMS system. They used propensity score matching to create a “pseudo-randomized comparison” between 307 patients treated with TMS and the same number of patients treated with medication in the Sequential Treatment for the Relief of Depression (STAR*D) study. For TMS-treated patients, the model hypothesized an average cost of $181 per cycle over 29 acute treatment cycles plus 6 decreasing cycles. For patients in the STAR*D study, the model assumed that patients were treated with a single antidepressant for 6 weeks, with additional medications added if they did not remit. Dr. Simpson said the analysis showed an increased cost-effectiveness ratio for TMS, with a cost of $36,383 per quality-corrected life year, which is less than the usually acceptable norm of $50,000, showing it to be well worth it. In the model, TMS cost an average of $11,886 per year, compared with $10,888 for patients treated with drugs in the STAR*D study-TMS cost $998 more per year. The researchers also calculated the cost per person per month (PMPM) through a medium-sized insurance company covering 6 million people, speculating that 2 percent of patients would not benefit from initial drug therapy, and 15 percent of those patients were treated with TMS. In this case, the researchers said, patients treated with TMS had a $0.25 increase in PMPM over drug therapy over 2 years. According to Dr. Simpson, the analysis showed that TMS was cost-effective compared with standard drug therapy for refractory MDD. She noted that patients with refractory MDD “are so ill that they would normally be treated with 2-3 antidepressants, but in many cases they are not effective. They have no choice but to take electroconvulsive therapy, but electroconvulsive therapy has side effects, whereas TMS has no real side effects.” Dr. Simpson said she would like to “see more patients treated with TMS, but it is a very new treatment and many patients still just go to their general practitioner and get a prescription for a selective 5-hydroxytryptamine reuptake inhibitor (SSRI).”