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Medical Journal of Islamic Republic of Iran، جلد ۳۰، شماره ۱، صفحات ۱۶۳-۱۷۴
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عنوان انگلیسی Economic evaluation of resistant major depressive disorder treat-ment in Iranian population: a comparison between repetitive Transcranial Magnetic Stimulation with electroconvulsive
چکیده انگلیسی مقاله Background: It is estimated that major depression disorders constitute 8.2% of years lived with disability (YLDs) globally. The repetitive Transcranial Magnetic Stimulation (rTMS) and Electroconvulsive Therapy (ECT) are two relative common interventions to treat major depressive disorders, especially for treatment resistant depression. In this study the cost- effectiveness and cost-utility of rTMS were compared with ECT in Iranian population suffering from major depressive disorder using a decision tree model. Methods: A decision tree model conducted to compare the cost-effectiveness ratio of rTMS with ECT in a health system prospective and 7 months' time horizon. The outcome variables were: response rate, remission rate and quality-adjusted life-years (QALYs) of the rTMS and ECT as primary and secondary outcomes extracted from systematic reviews and randomized control trials. The costs were also calculated through a field study in one clinic and one hospital; the direct costs have only been considered. Results: The total cost for rTMS and ECTstrategieswere11015000Rials (373US$) and 11742700 Rials (397.7US$), respectively. Also the rTMS/ECT ratio of costs per improved patients was 1194410Rials (40.5 US$); the ratio for costs per QALYs utility was 21017139 Rials (711.72 US$). The incremental cost- effectiveness ratio of rTMS versus ECT was 1194410 Rials (40.44 US$) after treatment and maintenance courses. Conclusion: Given the current prevalence of depressive disorders in Iranian population, the ECT is more cost-effective than TMS. The sensitivity analysis showed that if the prevalence of major depressive disorders declines to below 5% or the costs of rTMS decrease (rTMS provided by public sector), then the rTMS becomes more cost-effective compared with ECT. However, efficacy of rTMS depends on the frequency of pulsed magnetic field, the location of rTMS on the head, the number of therapeutic sessions and the length of each session.
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نویسندگان مقاله حسام غیاثوند | hesam ghiasvand
health services management research center, institute for futures studies in health, kerman university of medical sciences, ker-man, iran.

سازمان اصلی تایید شده: دانشگاه علوم پزشکی کرمان (Kerman university of medical sciences)

محمد مرادی جو | mohammad moradi joo
cancer research center, shahid beheshti university of medical sciences, tehran, iran.

سازمان اصلی تایید شده: دانشگاه علوم پزشکی شهید بهشتی (Shahid beheshti university of medical sciences)

نازنین ابوالحسنی | nazanin abolhassani
department of health management and economics, school of public health, tehran university of medical sciences, tehran, iran.

سازمان اصلی تایید شده: دانشگاه علوم پزشکی تهران (Tehran university of medical sciences)

حمید رواقی | hamid ravaghi
assistant professor, department of health services management, school of health management and information sciences, iran university of medical sciences, tehran, iran.

سازمان اصلی تایید شده: دانشگاه علوم پزشکی ایران (Iran university of medical sciences)

سید منصور رایگانی | seyed mansoor raygani
physical medicine and rehabilitation research center, shahid beheshti university of medical sciences, tehran, iran.

سازمان اصلی تایید شده: دانشگاه علوم پزشکی شهید بهشتی (Shahid beheshti university of medical sciences)

سحر محبت بهار | sahar mohabbat bahar
ferdowsi university of mashhad, faculty of psychology and educational sciences, mashhad, iran.

سازمان اصلی تایید شده: دانشگاه فردوسی (Ferdowsi university)

نشانی اینترنتی http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1-961&slc_lang=en&sid=en
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