Comparison between neurostimulation techniques repetitive transcranial magnetic stimulation vs electroconvulsive therapy for the treatment of resistant depression: patient preference and cost-effectiveness

Figures & data

Figure 1 21-item Hamilton Rating Scale for Depression (HDRS-21).

Abbreviations: ECT, electroconvulsive therapy; TMS, transcranial magnetic stimulation; SE, standard error.

Figure 2 Visual Analog Scale (VAS).

Abbreviations: ECT, electroconvulsive therapy; TMS, transcranial magnetic stimulation; SE, standard error.

Figure 3 Hamilton Anxiety Rating Scale (HARS).

Abbreviations: ECT, electroconvulsive therapy; TMS, transcranial magnetic stimulation; SE, standard error.

Figure 4 Beck Depression Inventory (BDI).

Abbreviations: ECT, electroconvulsive therapy; TMS, transcranial magnetic stimulation; SE, standard error.

Table 1 General description

	N	Male	Female
Number of patients and their sex	81	39	42
Number of patients in ECT	40	21	19
Number of patients in TMS	41	18	23
		Mean	Standard deviation
Age (years)	81	45.642	9.641
Years of education	81	13.148	2.214
Current episode	81	19.457	28.510
Number of lifetime episodes	81	2.395	1.069
Past psychotherapy/cognitive therapy	81	0.741	0.441
HDRS-21 baseline	81	26.802	3.172
HDRS-21 after treatments	81	14.802	13.688
HARS baseline	81	19.642	3.675
HARS after treatments	81	15.518	16.215
BDI baseline	81	25.197	4.247
BDI after treatments	81	11.457	4.093
VAS baseline	81	18.951	10.299
VAS after treatments	81	60.185	16.133

Abbreviations: HDRS, Hamilton Depression Rating Scale; HARS, Hamilton Anxiety Rating Scale; BDI, Beck Depression Inventory; VAS, Visual Analog Scale; ECT, electroconvulsive therapy; TMS, transcranial magnetic stimulation.

Table 2 Student’s t-test, independent samples

	Mean	N	Standard deviation	t-test	df	Significance (2-tailed)
Age, years (ECT)	47.175	40	8.808	1.422	79	0.159
Age, years (TMS)	44.146	41	10.277
Years of education (ECT)	12.775	40	1.702	−1.510	79	0.135
Years of education (TMS)	13.512	41	2.589
Current episode (ECT)	14.175	40	5.697	−1.665	79	0.100
Current episode (TMS)	24.610	41	39.228
Number of lifetime episodes (ECT)	2.250	40	0.926	−1.210	79	0.230
Number of lifetime episodes (TMS)	2.537	41	1.185
Past psychotherapy/cognitive therapy (ECT)	0.775	40	0.423	0.688	79	0.493
Past psychotherapy/cognitive therapy (TMS)	0.707	41	0.461

Abbreviations: ECT, electroconvulsive therapy; TMS, transcranial magnetic stimulation.

Table 3 Expenses and hospital income from the ECT-TMS treatments

	ECT		TMS
	Shekels	US$	Shekels	US$
Costs to HMO	1,226	318	–	–
Cost to patient (out of pocket)	–	–	450	117
Anesthesiologist expenses	200	52	–	–
Nursing staff expenses	140	36	–	–
Psychiatrist/resident in psychiatry expenses	60	16	60	16
Lease expenses of the TMS machine per daya	–	–	125	32
Daily department’s expensesb	100	26	100	26
Hospital earnings per treatment	726	188	165	43
Final incomec	7,986	2,075	3,135	814

Notes:

a Lease of the TMS machine costs 10,000 shekels per month. The TMS unit performs 80–120 treatments per month.

b For ECT, daily department expense (including drugs, monitors, beds, sheets, and an ECT machine) is 15,000 shekels per month. The ECT unit performs 150–250 treatments per month; for TMS, department expense (including the rent and services) is 8,000 shekels per month. The TMS unit performs 80–120 treatments per month.

c Patients complete 11.3±2.3 ECT treatments and 19.6±1.2 rTMS treatments, with total final income from ECT of 726×11=7,986 shekels ($2,074) and from TMS of 165×19=3,135 shekels ($814).

Abbreviations: ECT, electroconvulsive therap; TMS, transcranial magnetic stimulation; HMO, Health Maintenance Organization; rTMS, repetitive transcranial magnetic stimulation.