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Cost Analysis of Intermittent Theta Burst Stimulation (iTBS) Versus 10Hz Repetitive Transcranial Magnetic Stimulation (rTMS) in Patients with Treatment Resistant Depression

27 Pages Posted: 16 Jan 2019

See all articles by Andrew B. Mendlowitz

Andrew B. Mendlowitz

University of Toronto - Temerty Centre for Therapeutic Brain Intervention

Alaa Shanbour

University of Toronto - Department of Psychiatry

Jonathan Downar

University of Toronto - Department of Psychiatry

Fidel Vila-Rodriguez

University of British Columbia (UBC)

Zafiris J. Daskalakis

University of Toronto - Department of Psychiatry

Wanrudee Isaranuwatchai

University of Toronto

Daniel Blumberger

University of Toronto - Temerty Centre for Therapeutic Brain Intervention

More...

Abstract

Background: The THREE-D randomized non-inferiority trial found that 3 min intermittent theta burst stimulation (iTBS) had comparable effectiveness to the conventional 37·5 min 10Hz rTMS protocol in patients with depression. The shorter iTBS could improve clinic capacity and reduce the per session cost of rTMS. This study compared the potential cost per course and cost per remission for iTBS versus 10Hz rTMS in depression.

Methods: We conducted a cost analysis from a healthcare system perspective using patient-level data from the published THREE-D trial. Depressed adults 18 to 65 were randomized to receive either 10Hz rTMS or iTBS of the left dorsolateral prefrontal cortex. Treatment costs per patient were calculated using direct healthcare costs associated with equipment, coils, physician assessments and technician time over the entire course of treatment. Cost per remission was estimated using the proportion of patients achieving remission following treatment. Non-parametric bootstrapping was used to generate uncertainty intervals. Deterministic sensitivity analyses were performed to assess parameter uncertainty.

Outcomes: From a healthcare system perspective, the average cost per patient was USD$1,108 (SD 166) for a course of iTBS and $1,844 (SD 304) for 10Hz rTMS, with a net savings of $735 (95% CI 688 to 783) per patient. The average cost per remission was $3,695 (SD 552) for iTBS and $6,146 (SD 1,015) for 10Hz rTMS, with a net savings of $2,451 (95% CI 2,293 to 2,610) per remission.

Interpretation: The shorter session duration and treatment capacity increase with 3 min iTBS translate into significant cost-savings per patient and per remission when compared to 10Hz rTMS.

Funding: Canadian Institutes of Health Research.

Declaration of Interest: JD has received research support from CIHR, NIMH, Brain Canada, the Canadian Biomarker Integration Network in Depression, the Ontario Brain Institute, the Klarman Family Foundation, the Arrell Family Foundation, the Edgestone Foundation, a travel stipend from Lundbeck and from ANT Neuro, an advisor to BrainCheck and in-kind equipment support for this investigator-initiated trial from MagVenture. FVR receives research support from CIHR, Brain Canada, Michael Smith Foundation for Health Research, Vancouver Coastal Health Research Institute, and in-kind equipment support for this investigator-initiated trial from MagVenture. He has participated in an advisory board for Janssen. ZJD has received within the last 3 years both research and equipment in-kind support for an investigator-initiated study through Brainsway Ltd. and Magventure. DMB receives research support from the Canadian Institutes of Health Research (CIHR), National Institutes of Health – US (NIH), Weston Brain Institute, Brain Canada and the Temerty Family through the CAMH Foundation and the Campbell Research Institute. He received research support and in-kind equipment support for an investigator-initiated study from Brainsway Ltd. and he is the site principal investigator for three sponsor-initiated studies for Brainsway Ltd. He received in-kind equipment support from Magventure for this investigator-initiated study. He received medication supplies for an investigator-initiated trial from Indivior. He has participated in an advisory board for Janssen.

Ethical Approval: Written informed consent was obtained from all study participants and ethics approval was granted by the research ethics boards of all three institutions.

Keywords: cost analysis, repetitive transcranial magnetic stimulation (rTMS), Intermittent Theta Burst Stimulation (iTBS), treatment-resistant depression

Suggested Citation

Mendlowitz, Andrew B. and Shanbour, Alaa and Downar, Jonathan and Vila-Rodriguez, Fidel and Daskalakis, Zafiris J. and Isaranuwatchai, Wanrudee and Blumberger, Daniel, Cost Analysis of Intermittent Theta Burst Stimulation (iTBS) Versus 10Hz Repetitive Transcranial Magnetic Stimulation (rTMS) in Patients with Treatment Resistant Depression (August 1, 2019). Available at SSRN: https://ssrn.com/abstract=3314455

Andrew B. Mendlowitz

University of Toronto - Temerty Centre for Therapeutic Brain Intervention

1001 Queen Street West
Toronto, Ontario M6J 1H4
Canada

Alaa Shanbour

University of Toronto - Department of Psychiatry

Toronto, Ontario
Canada

Jonathan Downar

University of Toronto - Department of Psychiatry

Toronto, Ontario
Canada

Fidel Vila-Rodriguez

University of British Columbia (UBC)

2329 West Mall
Vancouver, British Columbia BC V6T 1Z4
Canada

Zafiris J. Daskalakis

University of Toronto - Department of Psychiatry

Toronto, Ontario
Canada

Wanrudee Isaranuwatchai

University of Toronto

Toronto, Ontario M5S 3G8
Canada

Daniel Blumberger (Contact Author)

University of Toronto - Temerty Centre for Therapeutic Brain Intervention ( email )

1001 Queen Street West
Toronto, Ontario M6J 1H4
Canada

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