Cost-utility analysis of repetitive transcranial magnetic stimulation and transcranial direct current stimulation as adjunctive therapies in Chinese patients with major depressive disorder.

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.