Table 20:
Scenario Analysis Results
| Scenario | High-Frequency rTMS vs. ECT | High-Frequency rTMS vs. Pharmacotherapy Alone | iTBS vs. ECT | iTBS vs. Pharmacotherapy Alone |
|---|---|---|---|---|
| Reference case (stepped care, 35% switching to ECT) | ICER ($/QALY): dominanta | ICER ($/QALY): 22,868 | ICER: dominanta | ICER ($/QALY): 21,259 |
| Δ C = −$11,938 | Δ C = $12,343 | Δ C = −$12,579 | Δ C = $11,703 | |
| Δ E (mean) = 0.1028 QALYs | Δ E (mean) = 0.5397 QALYs | Δ E (mean) = 0.1135 QALYs | Δ E (mean) = 0.5505 QALYs | |
| No switching to ECT (no stepped care) | ICER ($/QALY): dominanta | ICER ($/QALY): 23,157 | ICER ($/QALY): dominanta | ICER ($/QALY): 21,181 |
| Δ C = −$14,134 | Δ C = −$10,147 | Δ C = −$14,736 | Δ C = $9,545 | |
| Δ E (mean) = 0.0012 QALYs | Δ E (mean) = 0.4382 QALYs | Δ E (mean) = 0.0137 QALYs | Δ E (mean) = 0.4507 QALYs | |
| 100% switching to ECT (stepped care) | ICER ($/QALY): dominanta | ICER ($/QALY): 22,517 | ICER($/QALY): dominanta | ICER ($/QALY): 21,322 |
| Δ C = −$7,876 | Δ C = $16,405 | Δ C = −$8,587 | Δ C = $15,694 | |
| Δ E (mean) = 0.2991 QALYs | Δ E (mean) = 0.7285 QALYs | Δ E (mean) = 0.2991 QALYs | Δ E (mean) = 0.7360 QALYs | |
| 1-y time horizon | ICER ($/QALY): dominanta | ICER($/QALY): 37,630 | ICER($/QALY): dominanta | ICER($/QALY): 34,853 |
| Δ C = −$11,422 | Δ C = $7,669 | Δ C = −$11,857 | Δ C = $7,235 | |
| Δ E (mean) = 0.0068 QALYs | Δ E (mean) = 0.2038 QALYs | Δ E (mean) = 0.0106 QALYs | Δ E (mean) = 0.2076 QALYs | |
| Lifetime time horizon | ICER($/QALY): dominanta | ICER($/QALY): 15,880 | ICER($/QALY): dominanta | ICER($/QALY): 14,833 |
| Δ C = −$13,109 | Δ C = $32,155 | Δ C = −$14,711 | Δ C = $30,552 | |
| Δ E (mean) = 0.6101 QALYs | Δ E (mean) = 2.0249 QALYs | Δ E (mean) = 0.6449 QALYs | Δ E (mean) = 2.0597 QALYs | |
| Discount rate: 3% | ICER($/QALY): dominanta | ICER($/QALY): 23,045 | ICER($/QALY): dominanta | ICER($/QALY): 21,422 |
| Δ C = −$11,914 | Δ C = $12,191 | Δ C = −$12,548 | Δ C = $11,557 | |
| Δ E (mean) = 0.0997 QALYs | Δ E (mean) = 0.5290 QALYs | Δ E (mean) = 0.1102 QALYs | Δ E (mean) = 0.5395 QALYs | |
| Mortality rate due to severe depression decreased by 25% | ICER ($QALY): dominanta | ICER ($/QALY): 23,123 | ICER ($/QALY): dominanta | ICER ($/QALY): 21,490 |
| Δ C = −$11,938 | Δ C = $12,334 | Δ C = −$12,579 | Δ C = $11,693 | |
| Δ E (mean) = 0.1028 QALYs | Δ E (mean) = 0.5334 QALYs | Δ E (mean) = 0.01135 QALYs | Δ E (mean) = 0.5441 QALYs | |
| Mortality rate due to severe depression increased by 25% | ICER ($QALY): dominanta | ICER ($/QALY): 22,630 | ICER ($/QALY): dominanta | ICER ($/QALY): 21,043 |
| Δ C = −$11,938 | Δ C = $12,352 | Δ C = −$12,579 | Δ C = $11,711 | |
| Δ E (mean) = 0.1028 QALYs | Δ E (mean) = 0.5458 QALYs | Δ E (mean) = 0.01135 QALYs | Δ E (mean) = 0.5565 QALYs |
Abbreviations: ECT, electroconvulsive therapy; ICER, incremental cost-effectiveness ratio; iTBS, intermittent theta burst stimulation; QALY, quality-adjusted life-year; rTMS, repetitive transcranial magnetic stimulation; TRD, treatment-resistant depression.
a
Dominant is less costly and more effective.