A major new study has found that transcranial magnetic stimulation (TMS), which applies magnetic energy to the brain, can be a cost-effective treatment option for the NHS in treating moderate and severe forms of depression that have not responded to other treatments.
The economic analysis, which is published in BMJ Mental Health, compared TMS to usual care in specialist mental health services, and found that TMS reduces depressive symptoms, eases pressures on informal carers and on NHS resources, and helps people get back to work.
TMS represents an investment in care that recovers its costs over time, primarily from savings to the wider health service and from fewer workdays being lost because of long-term depression.
The study was led by senior health economist Edward Cox from the Nottingham Clinical Trials Unit at the University of Nottingham and Professor Richard Morriss from the Institute of Mental Health, National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, and the NIHR HealthTech Research Centre in Mental Health (MindTech).
Cox said: “Our economic analysis was informed via feedback from TMS experts across six mental health care services, and from the experiences of 442 participants suffering with difficult-to-treat forms of depression enrolled within two clinical trials.
“The study found that a proportion of patients receiving TMS therapies can expect to achieve faster and more sustained improvements in depressive symptoms compared to usual care, and that these gains represent a cost-effective allocation of scarce NHS resources.
“It’s important to recognise that the cost-effectiveness of TMS is dependent specifically on how it is going to be delivered in wider practice.
“Our study findings demonstrate that services that can achieve a streamlined high throughput model of care can expect to deliver a highly cost-effective treatment.
“Our findings should provide much needed evidence for policymakers to rationalise and establish cost-effective models for implementing TMS within the NHS.”
Major depression is the leading cause of disability lost years worldwide, and suicide from depression is one of the biggest killers of people aged between 15-49.
Antidepressants and therapy delivered as first or second-line treatments help two thirds of people with depression, but the remaining third have treatment resistant depression (TRD). This is defined as a lack of response to two courses of antidepressants.
TMS is an outpatient treatment where people have powerful magnetic pulses delivered to the left side of their head just in front of the temporal area of the scalp. The person is conscious and has at least 20 sessions over a four-to-six-week period.
Although TMS is safe and effective as a treatment for TRD and was approved in 2015 by the National Institute for Health and Care Excellence (NICE) for use in the NHS, it remains inaccessible for the majority of patients.
Although TMS was invented in the UK, the equipment produced by UK industry, and has been proven effective and implementable within mental health care services, it is only available in one in seven NHS Trusts.
One of the main reasons for this is the lack of evidence showing its value for money.
In this new study, experts set out to assess the cost-effectiveness of two forms of TMS, repetitive transcranial magnetic stimulation therapy (rTMS) and intermittent theta-burst stimulation (iTBS), compared to usual care for TRD.
The study also seeks to establish the operational circumstances in which TMS could be deemed to represent value-for-money to the NHS and wider society.
Susan Varley, a patient who has received a course of TMS therapy, said: “As a previously high functioning nurse, I suffered severe depression and had to be admitted to hospital because of the severity of my depression.
“I tried all sorts of different treatments for my depression. Nothing worked. I then travelled to receive a course of TMS and it has transformed my life.
“I am back working as a nurse, lost four stone in weight and I am enjoying life again with family and friends. I strongly believe that others suffering like me should be given the option of TMS under the NHS.”
