Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.

Background: Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are confl...

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Autores: Vallejo-Torres, L., Castilla, I., González, N., Hunter, R., Serrano-Pérez , P., Perestelo-Pérez, Lilisbeth|||/items/66d303fb-04ad-442e-9493-61ba61776b0a
Tipo de documento: artigo
Data de publicação:2015
País:España
Recursos:Universidad Alfonso X el Sabio
Repositório:Repositorio Institucional de la Universidad Alfonso X el Sabio
Idioma:inglês
OAI Identifier:oai:archive.uax.com:20.500.12080/55473
Acesso em linha:https://hdl.handle.net/20.500.12080/55473
Access Level:Acceso aberto
Palavra-chave:Estimulación magnética transcraneal repetitiva
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spelling Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.Vallejo-Torres, L.Castilla, I.González, N.Hunter, R.Serrano-Pérez , P.Perestelo-Pérez, Lilisbeth|||/items/66d303fb-04ad-442e-9493-61ba61776b0aEstimulación magnética transcraneal repetitivaBackground: Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are conflicting. Method: We conducted a cost-effectiveness analysis comparing ECT alone, rTMS alone and rTMS followed by ECT when rTMS fails under the perspective of the Spanish National Health Service. The analysis is based on a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives over a 12-month period. Data to populate this model were extracted and synthesized from a series of randomized controlled trials and other studies that have compared these techniques on the patient group of interest. We measure effectiveness using quality-adjusted life years (QALYs) and characterize the uncertainty using probabilistic sensitivity analyses. Results: ECT alone was found to be less costly and more effective than rTMS alone, while the strategy of providing rTMS followed by ECT when rTMS fails is the most expensive and effective option. The incremental cost per QALY gained of this latter strategy was found to be above the reference willingness-to-pay threshold used in these types of studies in Spain and other countries. The probability that ECT alone is the most cost-effective alternative was estimated to be around 70%. Conclusions: ECT is likely to be the most cost-effective option in the treatment of resistant severe depression for a willingness to pay of €30,000 per QALY.Cambridge University PressUAX -Campus MadridUAX Archive20152015-01-0120152015-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.12080/55473reponame:Repositorio Institucional de la Universidad Alfonso X el Sabioinstname:Universidad Alfonso X el SabioInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:archive.uax.com:20.500.12080/554732026-05-28T12:40:21Z
dc.title.none.fl_str_mv Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.
title Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.
spellingShingle Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.
Vallejo-Torres, L.
Estimulación magnética transcraneal repetitiva
title_short Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.
title_full Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.
title_fullStr Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.
title_full_unstemmed Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.
title_sort Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.
dc.creator.none.fl_str_mv Vallejo-Torres, L.
Castilla, I.
González, N.
Hunter, R.
Serrano-Pérez , P.
Perestelo-Pérez, Lilisbeth|||/items/66d303fb-04ad-442e-9493-61ba61776b0a
author Vallejo-Torres, L.
author_facet Vallejo-Torres, L.
Castilla, I.
González, N.
Hunter, R.
Serrano-Pérez , P.
Perestelo-Pérez, Lilisbeth|||/items/66d303fb-04ad-442e-9493-61ba61776b0a
author_role author
author2 Castilla, I.
González, N.
Hunter, R.
Serrano-Pérez , P.
Perestelo-Pérez, Lilisbeth|||/items/66d303fb-04ad-442e-9493-61ba61776b0a
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv UAX -Campus Madrid
UAX Archive
dc.subject.none.fl_str_mv Estimulación magnética transcraneal repetitiva
topic Estimulación magnética transcraneal repetitiva
description Background: Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are conflicting. Method: We conducted a cost-effectiveness analysis comparing ECT alone, rTMS alone and rTMS followed by ECT when rTMS fails under the perspective of the Spanish National Health Service. The analysis is based on a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives over a 12-month period. Data to populate this model were extracted and synthesized from a series of randomized controlled trials and other studies that have compared these techniques on the patient group of interest. We measure effectiveness using quality-adjusted life years (QALYs) and characterize the uncertainty using probabilistic sensitivity analyses. Results: ECT alone was found to be less costly and more effective than rTMS alone, while the strategy of providing rTMS followed by ECT when rTMS fails is the most expensive and effective option. The incremental cost per QALY gained of this latter strategy was found to be above the reference willingness-to-pay threshold used in these types of studies in Spain and other countries. The probability that ECT alone is the most cost-effective alternative was estimated to be around 70%. Conclusions: ECT is likely to be the most cost-effective option in the treatment of resistant severe depression for a willingness to pay of €30,000 per QALY.
publishDate 2015
dc.date.none.fl_str_mv 2015
2015-01-01
2015
2015-01-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.12080/55473
url https://hdl.handle.net/20.500.12080/55473
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Cambridge University Press
publisher.none.fl_str_mv Cambridge University Press
dc.source.none.fl_str_mv reponame:Repositorio Institucional de la Universidad Alfonso X el Sabio
instname:Universidad Alfonso X el Sabio
instname_str Universidad Alfonso X el Sabio
reponame_str Repositorio Institucional de la Universidad Alfonso X el Sabio
collection Repositorio Institucional de la Universidad Alfonso X el Sabio
repository.name.fl_str_mv
repository.mail.fl_str_mv
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