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Comparison between neurostimulation techniques rapid transcranial magnetic stimulation vs electroconvulsive therapy for the treatment of resistant depression: patient preference and cost-effectiveness

Authors Magnezi R, Aminov E, Shmuel D, Dreifuss M, Dannon P

Received 2 February 2016

Accepted for publication 4 May 2016

Published 4 August 2016 Volume 2016:10 Pages 1481—1487

DOI https://doi.org/10.2147/PPA.S105654

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Doris Leung

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Racheli Magnezi,1 Emanuel Aminov,1 Dikla Shmuel,2 Merav Dreifuss,1 Pinhas Dannon1,2

1Public Health and Health Systems Management Program, Department of Management, Bar-Ilan University, Ramat Gan, 2Beer Yaakov Mental Health Center affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Objectives:
Major depressive disorder (MDD) is a common disorder, widely distributed in the population, and is often associated with severe symptoms and functional impairment. It has been estimated that 30% of MDD patients do not benefit adequately from therapeutic interventions, including pharmacotherapy and psychotherapy. Treatment-resistant depression (TRD) is generally defined as a failure to achieve remission, despite therapeutic interventions.
Aim: The most effective treatment alternatives for TRD are hospitalization, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS). Here we compared the clinical effectiveness of ECT and TMS, including success rates, patient responses, side-effect profiles, and financial worthiness.
Results: We found that ECT (P<0.0001) was more effective than TMS (P<0.012) (not statistically significant in group effect) in TRD patients. However, ECT patients reported a higher percentage of side effects (P<0.01) and the TMS treatment scored better in terms of patient preference. The cost benefit of ECT was higher than that of TMS (US$2075 vs US$814). Patient’s preferences for treatment could be more intense in the TMS, if the TMS is included in the Health Maintenance Organization’s service list.
Conclusion: We propose that both of these treatment options should be available in psychiatric wards, thus expanding the therapeutic toolkit for TRD.

Keywords:
ECT, TMS, treatment-resistant depression, cost benefit, patient preference

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