Safety and efficacy of transcranial magnetic stimulation (TMS) and repetitive transcranial magnetic stimulation (rTMS) in treatment of major depressive disorder: Systematic reviews and meta-analysis

Background: Prevalence of major depressive disorder allocated significant contribution of disease burden in developed and developing countries because of involving active and productive age groups and communities in recent decades. Different methods are used to manage and treat this disorder that one of them is Transcranial Magnetic Stimulation (TMS). The purpose of this study was assessment of safety, effectiveness and cost-effectiveness of Transcranial Magnetic Stimulation and Repetitive Transcranial Magnetic Stimulation (rTMS) technology in treatment of major depressive disorder. Methods: In order to gather evidence, main databases Cochrane Library, Centre for Reviews and Dissemination (CRD), PubMed, Scopus, Trip, Embase, Inahta, PsycINFO, Google Scholar were searched with appropriate keywords and strategies. After quality assessment of studies, consequences of safety and efficacy of the technology were extracted and Stata 12 software was used, if needed, for meta-analysis. Findings: From a total of 273 studies, 43 studies were entered firstly and 8 studies were selected after final review. The amount of standardised mean difference (SMD) was equal to -0.3 with a %95 confidence interval of -0.82 to 0.23 for rTMS-treated group versus sham group with a substantial rate and significant heterogeneity (P < 0.001, I-Squared = 81.9%). Conclusion: Repetitive Transcranial Magnetic Stimulation is a method with significant and high safety. On other side, its efficacy, compared to sham group, is not very significant. © 2015, Isfahan University of Medical Sciences(IUMS). All rights reserved

Economic evaluation of resistant major depressive disorder treatment in Iranian population: A comparison between repetitive Transcranial Magnetic Stimulation with electroconvulsive

Background: It is estimated that major depression disorders constitute 8.2 of years lived with disability (YLDs) globally. The repetitive Transcranial Magnetic Stimulation (rTMS) and Electroconvulsive Therapy (ECT) are two relative common interventions to treat major depressive disorders, especially for treatment resistant depression. In this study the cost- effectiveness and cost-utility of rTMS were compared with ECT in Iranian population suffering from major depressive disorder using a decision tree model. Methods: A decision tree model conducted to compare the cost-effectiveness ratio of rTMS with ECT in a health system prospective and 7 months' time horizon. The outcome variables were: response rate, remission rate and quality-adjusted life-years (QALYs) of the rTMS and ECT as primary and secondary outcomes extracted from systematic reviews and randomized control trials. The costs were also calculated through a field study in one clinic and one hospital; the direct costs have only been considered. Results: The total cost for rTMS and ECTstrategieswere11015000Rials (373US) and 11742700 Rials (397.7US), respectively. Also the rTMS/ECT ratio of costs per improved patients was 1194410Rials (40.5 US); the ratio for costs per QALYs utility was 21017139 Rials (711.72 US). The incremental cost- effectiveness ratio of rTMS versus ECT was 1194410 Rials (40.44 US) after treatment and maintenance courses. Conclusion: Given the current prevalence of depressive disorders in Iranian population, the ECT is more cost-effective than TMS. The sensitivity analysis showed that if the prevalence of major depressive disorders declines to below 5 or the costs of rTMS decrease (rTMS provided by public sector), then the rTMS becomes more cost-effective compared with ECT. However, efficacy of rTMS depends on the frequency of pulsed magnetic field, the location of rTMS on the head, the number of therapeutic sessions and the length of each session