TMS Cost Effectiveness

Peter Forster Costs of Treatment, Treatments of Depression

“Is TMS Cost-Effective?” His provocative title of an article just published in psychiatric times which summarizes an Australian pharmaco-economic study.

In case you don’t want to read through the rest of this article, here is the summary:

“Australian researchers compared the cost-effectiveness of rTMS with pharmacotherapy in treatment-resistant patients with MDD (ie, those who have failed at least 2 courses of antidepressant therapy).1 They found that, although both pharmacotherapy and rTMS are clinically effective, rTMS is more cost-effective.”

The article notes that there’s only one other similar study of cost effectiveness and that one found that while TMS was costly it met the predetermined criteria for cost-effectiveness (less than $50,000 per quality adjusted life year – a way of measuring health improvement).

This Australian article took a further step of comparing TMS with pharmacotherapy. For those of you with an interest in the details here’s a summary of the method they used:

“To further explore the issue, the Australian research team1 used a 3-year Markov microsimulation model with 2-monthly cycles to compare costs and QALYs of rTMS and standard pharmacotherapy with a variety of commonly used antidepressant medications… Data were also extracted from published literature, cost reports, and expert opinion. Incremental cost-utility ratios and univariate and multivariate probabilistic sensitivity analyses were applied.”

Essentially, what they found was that while TMS was expensive, pharmacotherapy was actually more expensive when cost was adjusted for improvement’s in outcome. In other words TMS was more expensive but had significantly better outcomes and the fact that pharmacotherapy (in those who had already failed to trials of antidepressants) had generally poorer outcomes more than offset the somewhat lower costs.


1. Nguyen KH, Gordon LG. Cost effectiveness of repetitive transcranial magnetic stimulation versus antidepressant therapy for treatment resistant depression. Value Health. 2015;18:597-604.
2. Simpson KN, Welch MJ, Kozel FA, et al. Cost-effectiveness of transcranial magnetic stimulation in the treatment of major depression: a health economics analysis. Adv Ther. 2009;26:346-368. – See more.

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