The clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in severe depression: a multicentre pragmatic randomised controlled trial and economic analysis

McLoughlin DM, Mogg A, Eranti S, Pluck G, Purvis R, Edwards D, et al
Record ID 32007000523
English
Authors' objectives:

"The aim of this study was to investigate if rTMS was as effective as ECT in treating major depressive episodes and to perform a cost-effectiveness analysis."

(from executive summary)

Authors' results and conclusions: One patient was lost to follow-up at end of treatment and another eight at 6 months. The end-of-treatment HRSD scores were lower for ECT [95% confidence interval (CI) 3.40 to 14.05, p = 0.002], with 13 (59%) achieving remission compared with four (17%) in the rTMS group (p = 0.005). However, HRSD scores did not differ between groups at 6 months. BDI-II, VAMS and BPRS scores were lower for ECT at end of treatment and remained lower after 6 months. Improvement in subjective reports of side-effects following ECT correlated with antidepressant response. There was no difference between the two groups before or after treatment on global measures of cognition. Although individual treatment session costs were lower for rTMS than ECT, the cost for a course of rTMS was not significantly different from that for a course of ECT as more rTMS sessions were given per course. Service costs were not different between the groups in the subsequent 6 months but informal care costs were significantly higher for the rTMS group (p = 0.04) and contributed substantially to the total cost for this group during the 6-month follow-up period. There was also no difference in gain in QALYs for ECT and rTMS patients. Analysis of cost-effectiveness acceptability curves demonstrated that rTMS has very low probability of being more cost-effective than ECT.
Authors' recommendations: ECT is a more effective and potentially cost-effective antidepressant treatment than 3 weeks of rTMS as administered in this study. Optimal treatment parameters for rTMS need to be established for treating depression. More research is required to refine further the administration of ECT in order to reduce associated cognitive side-effects while maintaining its effectiveness.
Authors' methods: Review
Details
Project Status: Completed
URL for project: http://www.hta.ac.uk/1203
Year Published: 2007
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Clinical Trials, Phase III as Topic
  • Costs and Cost Analysis
  • Multicenter Study
  • Randomized Controlled Trials as Topic
  • Depression
  • Electroconvulsive Therapy
  • Transcranial Magnetic Stimulation
Contact
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: 2009 Queen's Printer and Controller of HMSO
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