Is TMS Becoming the Standard of Care?
In Part One, I introduced my journey with TMS, which started over 25 years ago. We also met Dr. Mark George, an early pioneer researcher of TMS as a treatment for Depression. Without his unbounded curiosity and visionary research, you might not be reading this. He collaborated with others to bring his vision to the world.
We also got a glimpse at ECT – electroconvulsive therapy. And we posed the question of TMS’ comparative cost benefit. Many patients proclaim TMS as the new standard of care for Treatment Resistant Depression. Let’s look now at the cost of TMS and its advantages.
Is TMS a ‘wise buy’?
Let’s glance at the numbers, from the perspective of many years’ experience with patients and payers. Each patient receives treatment 5 days a week, for 4-6 weeks. Treatment varies, based on the individual, their underlying diagnoses, prior treatment history, compliance with treatment protocols, and their own body’s response.
We’ll assume that each session costs $300-400. That cost range is then applied to the length of treatment, 28-42 days (4-6 weeks). The averages range from $8,000 – $12,000. Could be more, and could be less. Patients who need adjunctive medication or psychotherapy will incur additional expense.
By all accounts, ECT costs at least twice as much. Many ECT patients also require hospitalization and an anesthesiologist. In contrast, patients who receive TMS are capable of driving themselves home afterward.
So, Is TMS a ‘WiseBuy’?
According to the article “Wise Buy? Repetitive Transcranial Magnetic Stimulation”, Linda L. Carpenter, MD, a professor of psychiatry and human behavior at Brown University, opened a clinic with a Neuronetics device in 2009. From 7:30 in the morning until 6:30 at night, she now has two devices running full time. “Half of the people who come to my clinic have been hospitalized,” she says. “Many have had ECT.” TMS outpatient therapy works well for those who are barely holding on to their jobs and can’t check into a hospital.
At Carpenter’s clinic, a regular course of TMS therapy costs $6,000-$12,000. She also states that the savings are significant. According to Dr. Carpenter, hospitalization for ECT costs up to $20,000. “(With TMS) we can eliminate hospitalizations,” she says. And patient outcomes are impressive. “Our clinic’s response rate is 60%.”
What is a QALY?
Kit Simpson, a professor of public health at the Medical University of South Carolina, concludes that TMS is, indeed less expensive than ECT. “This is a good deal. This is a wise buy,” she says. That’s true for patients and it’s true for insurance companies.
Dr. Simpson and her associates have analyzed the costs of TMS in terms of QALYs, (Quality Adjusted Life Years). In the U.S., QALYs are an often-used industry benchmark for determining the cost effectiveness of a treatment. If the cost of a QALY is calculated at less than $50,000, it is deemed cost-effective. According to Simpson’s analysis, producing one TMS QALY costs $36,000.
Even Simpson’s previous studies, dating back to 2002, concluded that “If rTMS were to be made widely available clinically in the US, it would offer a substantial economic benefit over ECT in treating resistant depression. Using rTMS-to-ECT offers not only an economic advantage but also an increase in QALYs. This analysis suggests that rTMS would be a cost-effective treatment for depression compared with the current option of ECT alone.”
From all these perspectives, we can see that TMS is a good value, costs less than ECT, and has a range of additional benefits.
What is the potential for TMS?
“A substantial portion of consumers who have health insurance have access to a policy that covers at least a portion of rTMS treatment,” says Mark Demitrack, MD, a psychiatrist and the chief medical officer at Neuronetics. “And Medicare covers it in most jurisdictions.”
While only 30,000 people have been treated with TMS, at least 4 million might benefit if treated. “We’re at exceedingly small clinical penetration,” Demitrack says. In contrast, “about 100,000 to 150,000 people are treated with ECT each year”, he says.
Dr. George predicts that the cost of treatment will come down as additional research yields more efficient treatment protocols. “What if we could do it so they only had to come half that time, or could come for one day and get well? I’ve been working from a scientific viewpoint to make it more efficient — less time in the chair,” he says.