Philip G. Janicak, MD Professor, Department of Psychiatry, Rush University Medical Center, Chicago, IL
Sheila M. Dowd, PhD Assistant Professor, Department of Psychiatry, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
Jeffrey T. Rado, MD Assistant Professor, Department of Psychiatry and Medicine, Rush University Medical Center, Chicago, IL
Mary Jane Welch, DNP, APRN, BC, CIP Assistant Professor, College of Nursing, Director, Human Subjects Protection, Rush University Medical Center, Chicago, IL
DisclosuresDr. Janicak receives research/grant support from and is a consultant to and speaker for Bristol-Myers Squibb/Otsuka and Neuronetics, Inc. Dr. Dowd receives research/grant support from Neuronetics, Inc. and Otsuka and is a consultant to Neuronetics, Inc. Dr. Rado receives research/grant support from Eli Lilly and Company, Neuronetics, Inc., and Otsuka, is a consultant to Neuronetics, Inc., and is a speaker for Eli Lilly and Company. Dr. Welch reports no financial relationship with any company whose products are mentioned in this article, or with manufacturers of competing products.
The most serious risk is intracranial bleeding, which occurs in 2% to 3% of patients. Clearly, the risk-benefit ratio must be carefully considered.
Cost and reimbursement
Cost of treatment and potential for third-party reimbursement are important considerations for any risk-benefit analysis. Many patients who seek neuromodulation treatments will not have insurance or other coverage entitlements.28-30 Further, newer treatments are not routinely covered by insurance; however, individual case coverage may be allowed and some device manufacturers have programs to assist providers and patients obtain coverage.28-30 Even ECT, which has long been a covered treatment for major depression, is still considered investigational for other disorders. Thus, it is important to pre-certify with the patient’s health insurance provider before initiating treatment.
Clinical Point
Because newer neuromodulation therapies are not always covered by insurance, pre-certify with the patient’s insurance provider
Coverage, however, is not the only consideration when weighing cost effectiveness. Economic studies can assist with clinical and ethical decisions relating to treatment choice.31 These studies, however, need to be critically evaluated (eg, what costs were included in the analysis). Although direct costs are easier to evaluate, indirect costs—such as the patient’s ability to continue to work while receiving the treatment, caretaker availability during treatment, and whether treatment is an inpatient or outpatient procedure—are more difficult to evaluate and should be discussed with the patient. Because these specialized options have the potential to further benefit patients with depression and other neuropsychiatric disorders, it is essential to balance the pressures of cost containment with the need for more effective and better tolerated treatments.32-34
Related Resource
Brunoni AR, Teng CT, Correa C, et al. Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting. Arq Neuropsiquiatr. 2010;68(3):433-451.
