Estimating the potential savings with vagus nerve stimulation for treatment-resistant depression: a payer perspective^*

ABSTRACT

Objective: To provide a formula estimating potential reductions in healthcare utilization costs with adjunctive vagus nerve stimulation (VNS Therapy^†) in treatment-resistant depression (TRD).

† VNS Therapy is a trademark of Cyberonics, Inc., Houston, TX, USA

Methods: This payer-perspective formula incorporates costs of treatment as usual for TRD patients from a published analysis of the MarketScan private payer claims database and the 2004 Medicare 5% standard analytic file. Estimated remission and response rates are from the published VNS pilot and pivotal studies. Costs were converted to 2008 US dollars per the US Bureau of Labor Statistics medical care costs, consumer price index. Device and implantation costs were calculated at $28 336.

Results: From the MarketScan and pooled outcomes data (VNS pilot and pivotal studies), potential per patient savings (hospitalization directly and indirectly related to depression) was $2974 at 5 years of device life, $23 539 at 8 years (moderate cost reduction scenario); $12 914 at 5 years, $40 935 at 8 years (optimistic scenario). Corresponding break-even device life was 4.57 and 3.62 years, respectively. From the Medicare file and pooled outcomes, potential per patient savings (inpatient and outpatient directly and indirectly related to depression) was $8358 at 5 years of device life, $32 385 at 8 years (moderate scenario); $19 837 at 5 years, $52 473 at 8 years (optimistic scenario). Corresponding break-even device life was 3.96 and 3.18 years, respectively.

Conclusions: The formula allows an evaluation of expected reductions in healthcare costs as a function of input cost variables, efficacy rates, and benefit scenarios. Cited costs differ relative to care settings, diagnostic principles, and procedural volume. This formula can help assess moderate-to-longer-term economic benefits of VNS for a particular institution. Results suggested that potential reductions in healthcare costs with VNS for TRD may be substantial. Break-even device life for the scenarios presented ranges between 2.3 and 5.7 years.

Trial registration: ClinicalTrials.gov identifier: NCT00533832.

Key words: :

• Economics
• Healthcare costs
• Healthcare utilization
• Treatment-resistant depression
• Vagus nerve stimulation

Acknowledgments

Declaration of interest: Cyberonics, Inc. funded this study. LJC is a member of the Cyberonics Speakers' Bureau and has received reimbursement for travel associated with speaker training. He has not received honoraria for delivering presentations on the company's product and reports no financial interests (stock or otherwise) in Cyberonics. JCA is an employee and stockholder at Cyberonics. Analysis of the Medicare 5% standard analytic file for 2004 was provided by The Moran Company, with funding from Cyberonics. Medical writing services were provided by Natasha M. Green, MA, ELS, an employee and stockholder at Cyberonics; Lorraine M. Cherry, PhD, with funding from Cyberonics; Susan E. Siefert, ELS, CBC, an employee and stockholder of Cyberonics; and Penny Clowe, RN, MS, an employee and stockholder of Cyberonics. The authors actively participated in writing, reviewing and revising drafts, and read and approved the final manuscript. Clinical Trial Registration: The pivotal trial of vagus nerve stimulation for treatment-resistant depression is registered at ClinicalTrials.gov. Identifier: 00533832.

Appendix

The following complex mathematical equations are referred to in the main text of the paper:

Notes

* These data were presented as a poster: Cohen LJ, Bunker MT. Economic implications of vagus nerve stimulation therapy for treatment-resistant depression. US Psychiatric&Mental Health Congress, 2006: New Orleans, LA, USA

† VNS Therapy is a trademark of Cyberonics, Inc., Houston, TX, USA

* VNS Therapy is a trademark of Cyberonics, Inc., Houston, TX, USA