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Slejko JF, Mattingly TJ, Wilson A, Xie R, Chapman RH, Amill-Rosario A, dosReis S. Patient-Informed Value Elements in Cost-Effectiveness Analyses of Major Depressive Disorder Treatment: A Literature Review and Synthesis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02404-5. [PMID: 38852668 DOI: 10.1016/j.jval.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/24/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES Prior work identified 6 key value elements (attributes of treatment and desired outcomes) for individuals living with major depressive disorder (MDD) in managing their condition: mode of treatment, time to treatment helpfulness, MDD relief, quality of work, interaction with others, and affordability. The objective of our study was to identify whether previous cost-effectiveness analyses (CEAs) for MDD treatment addressed any of these value elements. A secondary objective was to identify whether any study engaged patients, family members, and caregivers in the model development process. METHODS We conducted a systematic literature review to identify published model-based CEAs. We compared the elements of the published studies with the MDD patient value elements elicited in prior work to identify gaps and areas for future research. RESULTS Of 86 published CEAs, we found that 7 included patient out-of-pocket costs, and 32 included measures of productivity, which were both priorities for individuals with MDD. We found that only 2 studies elicited measures from patients for their model, and 2 studies engaged patients in the modeling process. CONCLUSIONS Published CEA models for MDD treatment do not regularly include value elements that are a priority for this patient population nor do they include patients in their modeling process. Flexible models that can accommodate elements consistent with patient experience are needed, and a multistakeholder engagement approach would help accomplish this.
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Affiliation(s)
- Julia F Slejko
- Patient-Driven Values in Healthcare Evaluation (PAVE) Center, Department of Practice, Sciences and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - T Joseph Mattingly
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Alexandra Wilson
- Patient-Driven Values in Healthcare Evaluation (PAVE) Center, Department of Practice, Sciences and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Richard Xie
- Innovation and Value Initiative, Alexandria, VA, USA
| | | | - Alejandro Amill-Rosario
- Patient-Driven Values in Healthcare Evaluation (PAVE) Center, Department of Practice, Sciences and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Susan dosReis
- Patient-Driven Values in Healthcare Evaluation (PAVE) Center, Department of Practice, Sciences and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Tor PC, Barreiros AR, Cao TV, Dong V, Brettell L, Tuneu CM, Galvez V, Waite S, Sarma S, Branjerdporn G, Chatterton ML, Mohan T, Hussain S, Martin D, Loo C. Why You Should Collect Routine Clinical Data for ECT: A Singapore Story From the CARE Network. J ECT 2024:00124509-990000000-00157. [PMID: 38587407 DOI: 10.1097/yct.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Phern-Chern Tor
- From the Department of Mood and Anxiety, Institute of Mental Health, Singapore
| | | | - Thanh Vinh Cao
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Vanessa Dong
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Louise Brettell
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Clara Massaneda Tuneu
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Veronica Galvez
- Mental Health and Addiction Searvice, Parc Tauli University Hospital, I3PT-CERCA, Barcelona, Spain
| | - Sue Waite
- The Queen Elizabeth Hospital, Woodville South
| | | | | | | | | | - Salam Hussain
- Sir Charles Gairdner Hospital, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Royal Australian and New Zealand College of Psychiatrists, Nedlands, Australia
| | - Donel Martin
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
| | - Colleen Loo
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Black Dog Institute, Randwick
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Fitzgerald PB, Gill S, Breakspear M, Kulkarni J, Chen L, Pridmore S, Purushothaman S, Galletly C, Clarke P, Ng F, Hussain S, Chamoli S, Csizmadia T, Tolan P, Cocchi L, Ibrahim Oam S, Shankar K, Sarma S, Lau M, Loo C, Yadav T, Hoy KE. Revisiting the effectiveness of repetitive transcranial magnetic stimulation treatment in depression, again. Aust N Z J Psychiatry 2022; 56:905-909. [PMID: 34969310 DOI: 10.1177/00048674211068788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Following on from the publication of the Royal Australian and New Zealand Journal of Psychiatry Mood Disorder Clinical Practice Guidelines (2020) and criticisms of how these aberrantly addressed repetitive transcranial magnetic stimulation treatment of depression, questions have continued to be raised in the journal about this treatment by a small group of authors, whose views we contend do not reflect the broad acceptance of this treatment nationally and internationally. In fact, the evidence supporting the use of repetitive transcranial magnetic stimulation treatment in depression is unambiguous and substantial, consisting of an extensive series of clinical trials supported by multiple meta-analyses, network meta-analysis and umbrella reviews. Importantly, the use of repetitive transcranial magnetic stimulation treatment in depression has also been subject to a series of health economic analyses. These indicate that repetitive transcranial magnetic stimulation is a cost-effective therapy and have been used in some jurisdictions, including Australia, in support of public funding. An argument has been made that offering repetitive transcranial magnetic stimulation treatment may delay potentially effective pharmacotherapy. In fact, there is considerably greater danger of the opposite happening. Repetitive transcranial magnetic stimulation is as, if not more effective, than antidepressant medication after two unsuccessful medication trials and should be a consideration for all patients under these circumstances where available. There is no meaningful ongoing debate about the use of repetitive transcranial magnetic stimulation treatment in depression - it is a safe, effective and cost-effective treatment.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, VIC, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Shane Gill
- The University of Adelaide, Adelaide, SA, Australia.,SAPBTC, Glenside Health Service, Glenside, SA, Australia.,Discipline of Psychiatry, The Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Michael Breakspear
- Discipline of Psychiatry, College of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Jayashri Kulkarni
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Leo Chen
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Saxby Pridmore
- Saint Helens Private Hospital, Hobart, TAS, Australia.,Discipline of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | | | - Cherrie Galletly
- Discipline of Psychiatry, The Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia.,Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Patrick Clarke
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Felicity Ng
- Discipline of Psychiatry, The Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Salam Hussain
- Section for ECT and Neurostimulation, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia.,The University of Western Australia, Perth, WA, Australia.,Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | | | - Patrick Tolan
- Alfred Health/Peninsula Health, Melbourne, VIC, Australia
| | | | - Samir Ibrahim Oam
- TMS Northpark Private Hospital, Bundoora, VIC, Australia.,Wyndham Private Clinic, Werribee, VIC, Australia
| | - Kavitha Shankar
- TMS Clinics Australia, Sydney, NSW, Australia.,St John of God Pinelodge Clinic, Dandenong, VIC, Australia
| | - Shanthi Sarma
- Bond University, Robina, QLD, Australia.,Gold Coast Health, Southport, QLD, Australia
| | - Michael Lau
- TMS Clinics Australia, Sydney, NSW, Australia.,Monarch Mental Health Group, Sydney, NSW, Australia.,Hornsby Ku-Ring-Gai Adult Mental Health Unit, Hornsby, NSW, Australia
| | - Colleen Loo
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Tarun Yadav
- Hunter New England Drug and Alcohol Service, Newcastle, NSW, Australia.,Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Kate E Hoy
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, VIC, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia
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Zemplényi A, Józwiak-Hagymásy J, Kovács S, Erdősi D, Boncz I, Tényi T, Osváth P, Voros V. Repetitive transcranial magnetic stimulation may be a cost-effective alternative to antidepressant therapy after two treatment failures in patients with major depressive disorder. BMC Psychiatry 2022; 22:437. [PMID: 35764989 PMCID: PMC9238085 DOI: 10.1186/s12888-022-04078-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/20/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The cost-effectiveness of treatment strategies for patients with Major Depressive Disorder (MDD) who have not responded to two adequate treatments with antidepressants (TRD) are still unclear. The aim of this analysis was to evaluate the cost-effectiveness of add-on repetitive Transcranial Magnetic Stimulation (rTMS) compared with standard treatment. METHODS A Markov-model simulated clinical events over one year from the perspective of healthcare payer. Third- and fourth-line treatment pathways (augmentation, antidepressant switch or combination, and Electro-Convulsive Therapy (ECT)) were defined based on medical practice guidelines. Transition probabilities were derived from a recent meta-analysis and scientific publications. Resource utilization and cost estimates were based on the patient-level database of a large university hospital. RESULTS Incremental Quality-Adjusted Life Years (QALYs) and costs were 0.053 and 785 €, respectively, corresponding to an Incremental Cost-Effectiveness Ratio (ICER) of 14,670 € per QALY. The difference in cost between standard treatment and rTMS is explained by the rTMS sessions used in acute (€660) and maintenance (€57/month) treatments, partly offset by lower hospital costs due to higher remission rates in the rTMS arm. Key parameters driving the ICER were incremental utility of remission, unit cost of rTMS treatment and remission rate. At a threshold of €22,243 add-on rTMS is a cost-effective alternative to pharmacotherapy. Evidence on long-term effectiveness is not yet available, so results are estimated for a one-year period. CONCLUSION Not only does rTMS treatment have beneficial clinical effects compared with drug therapy in TRD, but it also appears to offer good value-for-money, especially in centres with larger numbers of patients where unit costs can be kept low.
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Affiliation(s)
- Antal Zemplényi
- Centre for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Rákóczi street 2, Pécs, H-7623, Hungary.
| | - Judit Józwiak-Hagymásy
- grid.9679.10000 0001 0663 9479Centre for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Rákóczi street 2, Pécs, H-7623 Hungary
| | - Sándor Kovács
- grid.9679.10000 0001 0663 9479Centre for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Rákóczi street 2, Pécs, H-7623 Hungary
| | - Dalma Erdősi
- grid.9679.10000 0001 0663 9479Centre for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Rákóczi street 2, Pécs, H-7623 Hungary
| | - Imre Boncz
- grid.9679.10000 0001 0663 9479Institute for Health Insurance, Faculty of Health Sciences, University of Pecs, Pécs, Hungary
| | - Tamás Tényi
- grid.9679.10000 0001 0663 9479Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Péter Osváth
- grid.9679.10000 0001 0663 9479Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Viktor Voros
- grid.9679.10000 0001 0663 9479Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
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