Hospital production cost of direct transcranial stimulation (tDCS) in the treatment of depression

Abstract

Introduction Transcranial Direct Current Stimulation (tDCS), a medical device, has Grade B evidence-based efficacy for treatment-naive depressive patients, or with treatment, and no resistance. Its ease of use, its good tolerance and its cost of acquisition, lower than transcranial magnetic stimulation and electroconvulsive therapy, make it a good candidate as a therapeutic alternative in non-resistant depressions in primary care, associated with a medication management. No pricing or economic valuation currently exists for the tDCS in psychiatry. To our knowledge, no medical-economic evaluation has been conducted on tDCS. The objective of this study is to evaluate the cost of producing tDCS in the treatment of depression in hospitals, in real and pragmatic conditions. Methodology The methodology, derived from cost accounting, was validated by a multidisciplinary working group (clinicians, public health doctors, pharmacists, administrative, financial and health economists). Pragmatic, based on official and institutional documentary sources and field practice, she integrated the costs of materials, personnel and structure, to have an estimate closer to reality. We first estimated the cost of producing a tDCS session, based on our annual activity goal, and then the cost of a 15-session course. Sensitivity analysis, based on relevant parameters, supplemented these estimates. Results The cost of hospital production of a tDCS treatment in the treatment of depression was estimated at 1555.6 euros (99 € of material, 1 076.95 € of staff, 379.65 € of structural charges). Conclusion This cost analysis should be able to serve as a basis for other replication work, in other conditions (outpatient centers, specialized institutions, clinics), to arrive at a more general average estimate, with cost variability studies. And allow the development of pricing proposals, in compliance with regulations and health policy choices, and the development of medico-economic studies.