Assessment of cost-effectiveness of rTMS and ECT treatments in treatment-resistant major depression cases: A meta-analysis study

Health technology assessment (HTA) enables managers to make scientific decisions, especially regarding reimbursement, pricing, and the use of technology. Within this thesis, cost-effectiveness analyses of rTMS and ECT treatment were conducted for treatment-resistant depression with HTA methodology. A meta-analysis were done for the differences before and after treatment with the Hamilton depression ranking scale, response, remission, and discontinuation. For cost, the data of people 18+ who received rTMS and ECT treatment with ICD-10 codes F32-F33 and received rTMS and ECT treatment from the e-nabiz system for 2019 in Türkiye, as well as post-treatment prescription, consultation, and analysis requests, were clarified by obtaining expert opinions. The data from invoices to the SSI was analyzed. Costs were calculated from the payment institution perspective using the SUT, and effectiveness was calculated for one year using the values specified in the literature, and the decision tree model was used. ECT treatment was associated with a higher decrease in HDRS scores, indicating improvement in depression compared to rTMS (Hedge's g 0.59 (95%CI -0.09–1.27; p=0.09)). The response to treatment was RR 0.84 (95%CI 0.61–1.16 p = 0.28), and the remission rate was RR 0.99 (95% CI 0.59–1.64 p=0.96), favoring ECT. The risk of treatment discontinuation was higher in ECT compared to rTMS (RD) -0.07 (95%CI -0.14 to -0.01; p=0.02). In non-psychotic patients, response to treatment was better in rTMS (RR 1.07 (95%CI 0.73–1.55, p=0.74)). According to the cost-effectiveness analysis, the cost/QALY in rTMS was ₺788,19, while the cost/QALY in ECT was ₺8,960.12. The incremental cost-effectiveness ratio (ICER) is ₺68,827.97. 1-3 times of GDP in 2019 was between ₺52,213 to ₺156,639. So ECT is cost-effective than rTMS. However, in non-psychotic patients, the cost/QALY of rTMS is ₺801,88, and ECT is ₺10,970.1. ICER is ₺171,867.2. So in non-psychotic patients, rTMS was cost-effective than ECT.