Cost-effectiveness analysis of deep transcranial magnetic stimulation relative to evidence-based strategies for treatment-refractory obsessive-compulsive disorder

Journal: Journal of Psychiatric Research 146:50-54 (2022)

Authors: Sean T. Gregory, Wayne K. Goodman, Brian Kay, Bradley Riemann, Eric A. Storch

Background:

OCD affects ~1.2% of individuals each year and confers significant impairmentApproximately 40–60% of adults respond to SRIs; CBT response rates range from 70 to 85%However, partial- and non-response is common, resulting in a sizable number of treatment refractory individuals Deep TMS provides an additional intervention option for adults with treatment refractory OCD but the cost-effectiveness of this approach relative to others is unclear making it difficult to determine at what point in the continuum of care this intervention should be utilized and covered by third party payers.

Objective:

Examine the cost-effectiveness of Deep TMS for treatment refractory OCD relative to other established treatment options, including antidepressant medication (ADM), ADM + antipsychotic augmentation, real-world cognitive-behavioral therapy (ADM + CBT Effectiveness), clinical trial CBT (ADM + CBT), intensive outpatient program (IOP), partial hospitalization program (PHP), and PHP to IOP stepdown.

Methods:

A decision analytic model was developed to evaluate the cost-effectiveness of Deep TMS relative to other established treatment alternatives for adults (18–64 years old) with refractory OCD. Building on Gregory et al. (2018), the model was parameterized with probabilistic and deterministic parameters from the literature and an outcomes database to perform a Monte Carlo simulation of a hypothetical cohort of 100,000 adults with OCD to estimate costs, and incremental cost-effectiveness ratio (ICER) for Deep TMS relative to each treatment strategy. Encounters took place from 2012 to 2015. Data for Deep TMS were taken from a recent multisite study.

Results:

Although Deep TMS fit between ADM and ADM + CBT in overall costs, ADM + CBT had the lowest ICER and thus would be chosen before Deep TMS. Deep TMS was determined to be more cost effective relative to PHP/IOP stepdown, PHP, and IOP.

Conclusions:

Deep TMS is cost-effective, along the treatment continuum from outpatient medication management and CBT to more intensive, facilities-based approaches, and may be an incremental strategy to employ when higher intensity strategies are either not available, not financially feasible, or whilst on extended waits for admission to these higher levels of care.

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