Cost effectiveness of ECT versus rTMS
On this blog a lot of posts are about rapid Transcranial Magnetic Stimulation (rTMS), in short Dr Shock is not convinced that rTMS is effective in depression. On Therapeutic Modulation there is an abstract of a recent published study in the Journal of Affective Disorders about the cost effectiveness of rTMS versus electroconvulsive therapy (ECT).
Their conclusion:
Informal care costs were higher for the rTMS group. Total treatment, service and informal care costs were also higher for the rTMS group. The cost-effectiveness acceptability curves indicated a very small probability that decision-makers would view rTMS as more cost-effective than ECT.
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July 20, 2008 @ 4:45 pm
Hi Doc,
I wanted to take a quick moment to congratulate you on your new website. I’m sure it will be informational and even better and more beneficial to those challenged by these extremely serious mood disorders.
I didn’t have a chance to read into this topic other than the headline but I did want to comment from the standpoint of an extremely long-time support person and caregiver to my spouse. While money (costs) and statistical data (scientific) is certainly something we would all like to obtain in order to make an educated judgment before seeking treatment the fact still remains, at least in my thoughts, that your profession still remains more an art form than a scientific discipline. Theories abound without solid quantitative diagnostic means to substantiate what I personally consider subjective tests and conclusions.
While the data may be lacking or weak for rTMS and similarly for VNS as we discussed previously, the point is I personally would still opt for trying these other innovative neuro-modulation therapies knowing as I do the potential damaging side-effects especially of bi-lateral ECT has upon memory and/or cognition. This is not to say I am against ECT. To the contrary, when other options fail and one’s life is on the line, ECT is a viable option too only they’re other additional alternatives therapies to consider knowing as I do of the short lived potential efficacy of ECT.
Once again, congratulations upon your new site and as always thanks for giving me the opportunity to express my thoughts from a different perspective.
Warmly,
Herb
VNSdepression.com
July 20, 2008 @ 8:30 pm
Dear Herb,
The whole of medicine is an art but mostly the part in connecting with patients and in severe or difficult cases in trying other possibilities. But most of all medicine and even psychiatry is a science. I am certainly not against rTMS or VNS, but these new forms of neurostimulation are not supported by a lot of “me too” open research. rTMS is still in it’s infancy and is benefited by serious research such as placement, frequency etc.
Take care Dr Shock