Evaluating the Evidence on Comparative Effectiveness and Value of Management Options for Treatment-Resistant Depression

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Sarah K. Emond, MPP; Daniel A. Ollendorf, MPH, ARM; Jennifer A. Colby, PharmD; Sarah Jane Reed, MSc; Steven D. Pearson, MD, MSc, FRCP

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Postgraduate Medicine:

Volume 125 No. 6


Clinical Focus

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DOI: 10.3810/pgm.2013.11.2707
Abstract: Treatment-resistant depression (TRD) is a debilitating patient condition with significant clinical and economic impact. The introduction of a new treatment approach, repetitive transcranial magnetic stimulation (rTMS), created the opportunity for a multi-stakeholder initiative to examine the comparative clinical effectiveness and comparative value of the different approaches to managing patients with TRD. The New England Comparative Effectiveness Public Advisory Council (CEPAC) convened in December 2011 to discuss the evidence on management options for patients with TRD. The Council voted that rTMS was as good or better than usual care and represented a reasonable value compared with usual care. The votes and deliberation of CEPAC led to first-in-the-nation payer coverage policies allowing patients access to this new treatment option. Regional groups that examine and deliberate on the comparative effectiveness evidence for existing and emerging treatments can have a direct influence on medical policy that accelerates access to innovative treatments.

Keywords: treatment-resistant depression; repetitive transcranial magnetic stimulation; evidence-based medicine; comparative effectiveness research