Hospital production cost of transcranial direct current stimulation (tDCS) in the treatment of depression - 28/11/18

Doi : 10.1016/j.neucli.2018.11.001

Anne Sauvaget ^a,^b,^⁎ , Agathe Tostivint ^a, François Etcheverrigaray ^c, Anne Pichot ^a, Cécile Dert ^d, Solène Schirr-Bonnais ^d, Johann Clouet ^e,^f,^g,^h, Olivier Sellal ^f, Nicolas Mauduit ⁱ, Christophe Leux ⁱ, Clémence Cabelguen ^a, Samuel Bulteau ^a,^j, Valéry-Pierre Riche ^d
^a Addictology and liaison psychiatry department, Nantes university hospital, CHU de Nantes, Nantes, France
^b Laboratory “movement, interactions, performance” (EA 4334), faculty of sport sciences, university of Nantes, Nantes, France
^c Pharmacie, centre hospitalier départemental (CHD) Vendée, 85925 La Roche-sur-Yon, France
^d Innovation cell, partnership and innovation department, directorate of medical affairs and research, CHU de Nantes, Nantes, France
^e INSERM, UMR 1229, RMeS, regenerative medicine and skeleton, université de Nantes, ONIRIS, 44042 Nantes, France
^f Pharmacie Centrale, CHU Nantes, PHU 11, 44093 Nantes, France
^g UFR sciences biologiques et pharmaceutiques, université de Nantes, 44035 Nantes, France
^h UFR odontologie, université de Nantes, 44042 Nantes, France
ⁱ Department of medical information, CHU de Nantes, Nantes, France
^j Inserm U1246 Sphere “methodS in Patient-centered outcomes and HEalth ResEarch”, Nantes university, institute of health research IRS, 44200 Nantes, France

^⁎Corresponding author at: Neuromodulation unit, addictology and liaison psychiatry department, Nantes university hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.Neuromodulation unit, addictology and liaison psychiatry department, Nantes university hospital1, place Alexis-RicordeauNantes cedex 144093France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 28 November 2018
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Summary

Objectives

Due to its ease of use, tolerance, and cost of acquisition, transcranial direct current stimulation (tDCS) could constitute a credible therapeutic option for non-resistant depression in primary care, when combined with drug management. This indication has yet to receive official recognition in France. The objective of this study is to evaluate the production cost of tDCS for the treatment of depression in hospitals, under realistic conditions.

Methods

The methodology adopted is based on cost accounting and was validated by a multidisciplinary working group. It includes equipment, staff, and structural costs to obtain the most realistic estimate possible. We first estimated the cost of producing a tDCS session, based on our annual activity objective, and then estimated the cost of a 15-session treatment program. This was followed up with a sensitivity analysis applying appropriate parameters.

Results

The hospital production cost of a tDCS depression treatment program for a single patient was estimated at €1555.60 euros: €99 in equipment costs, €1076.95 in staff costs, and €379.65 in structural costs.

Conclusion

This cost analysis should make it possible to draw up pricing proposals in compliance with regulations and health policy choices and to develop health-economic studies. This would ultimately lead to official recognition of tDCS treatment for depression in France and pave the way for studying various scenarios of coverage by the French national health insurance system.

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Keywords : Cost, Depression, Health Economics, Neurostimulation, Psychiatry, TDCS