BMC psychiatry · 2026
Cost-utility analysis of repetitive transcranial magnetic stimulation and transcranial direct current stimulation as adjunctive therapies in Chinese patients with major depressive disorder.
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Li Wenxuan, Liu Qiao, Luo Jiani, Tan Shenglan
Аннотация
OBJECTIVE: Major depressive disorder (MDD) imposes a substantial burden in China, with many patients showing an inadequate response to first-line drugs. While repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) show promise, their economic value remains uncertain. This study aims to evaluate the cost-effectiveness of rTMS, tDCS, and their combination as adjunctive therapies for MDD in China.
METHODS: A 4-week Markov model used efficacy data from a Phase II trial (ChiCTR2100052122). Four strategies were compared: drug therapy alone, drug plus rTMS, drug plus tDCS, and combined therapy (rTMS+tDCS+drug). Direct and indirect costs were recorded weekly. Outcomes were quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. The willingness-to-pay (WTP) threshold was 1-3 times China's 2024 GDP per capita (¥95,749 - ¥287,247 per QALY). Deterministic and scenario analyses tested robustness and longer treatment durations.
RESULTS: All combination therapies outperformed drug therapy alone. The ICERs for rTMS, tDCS, and combined therapy were ¥113,174/QALY, ¥130,194/QALY, and ¥177,569/QALY, respectively - all below the WTP threshold. Compared with rTMS, tDCS showed better cost-effectiveness. The results were robust in sensitivity analyses, and tDCS's economic advantage grew with longer treatment duration.
CONCLUSIONS: In the Chinese healthcare context, both rTMS and tDCS as adjuncts to pharmacotherapy are cost-effective, with tDCS showing a better cost-effectiveness ratio and increasingly prominent benefits in long-term treatment.
METHODS: A 4-week Markov model used efficacy data from a Phase II trial (ChiCTR2100052122). Four strategies were compared: drug therapy alone, drug plus rTMS, drug plus tDCS, and combined therapy (rTMS+tDCS+drug). Direct and indirect costs were recorded weekly. Outcomes were quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. The willingness-to-pay (WTP) threshold was 1-3 times China's 2024 GDP per capita (¥95,749 - ¥287,247 per QALY). Deterministic and scenario analyses tested robustness and longer treatment durations.
RESULTS: All combination therapies outperformed drug therapy alone. The ICERs for rTMS, tDCS, and combined therapy were ¥113,174/QALY, ¥130,194/QALY, and ¥177,569/QALY, respectively - all below the WTP threshold. Compared with rTMS, tDCS showed better cost-effectiveness. The results were robust in sensitivity analyses, and tDCS's economic advantage grew with longer treatment duration.
CONCLUSIONS: In the Chinese healthcare context, both rTMS and tDCS as adjuncts to pharmacotherapy are cost-effective, with tDCS showing a better cost-effectiveness ratio and increasingly prominent benefits in long-term treatment.