Resource utilization and economic outcomes following repetitive transcranial magnetic stimulation for treatment-resistant depression: a retrospective observational analysis

Aim: We investigated the impact of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression on healthcare resource utilization as well as commercial and Medicare Fee-for-Service payer costs. Materials & methods: We conducted a retrospective observational analysis of claims data using Medicare Fee-for-Service datasets and commercial (Merative MarketScan Research Databases) datasets from 1 January 2021 to 30 September 2023. We identified two cohorts, a cohort that received rTMS and a cohort not treated with rTMS over an 18-month period. We used propensity score matching to balance the baseline characteristics of the cohorts, and we calculated the total cost of care based on payer allowed amounts from Merative MarketScan Research Databases and Standard Analytical Files. Results: Relative to the non-TMS cohort, the rTMS cohort incurred 37% more hospital outpatient visits (14.00 vs 10.21; p ≤ 0.0001) with 7% higher outpatient cost ($8946 vs $8363; p = 0.3400). Simultaneously, the rTMS cohort incurred 24% fewer inpatient admissions (0.25 vs 0.33; p = 0.0003) with 19% lower inpatient admission costs ($5666 vs $6978; p = 0.0392), 48% fewer emergency room visits (0.27 vs 0.53; p ≤ 0.0001) with 34% lower emergency room costs ($322 vs $487; p ≤ 0.0001), and $893 less in episode of care costs. Conclusion: This study suggests that patients who receive rTMS for treatment-resistant depression required fewer high acuity hospital visits and incurred less expensive episode-of-care costs compared with patients who do not receive rTMS. From this perspective, rTMS is an investment that returns health and economic dividends through fewer high acuity hospital visits.