— Majority of panel votes that evidence supports use of new, emerging technique for treatment-resistant depression: transcranial magnetic stimulation —
Boston, Mass., January 5, 2012 – Members of the New England Comparative Effectiveness Public Advisory Council (CEPAC) recently convened in Providence, RI to deliberate and vote on the evidence on the clinical effectiveness and comparative value of nonpharmacologic interventions for patients with treatment-resistant depression. This meeting examined the evidence on four interventions: transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), vagus nerve stimulation and cognitive behavioral and/or interpersonal therapy. CEPAC is the central component of a project funded by the Agency for Healthcare Research and Quality (AHRQ), and directed by the Institute for Clinical and Economic Review (ICER), a leading academic comparative effectiveness research group based at the Massachusetts General Hospital’s Institute for Technology Assessment.
Currently, state Medicaid programs, Medicare, and major private insurers do not cover vagus nerve stimulation or TMS for depression, but some Medicare medical directors are reconsidering their coverage policy for TMS. CEPAC voted 15 to 0 that the evidence was inadequate to determine the effectiveness of vagus nerve stimulation but voted 10 to 5 that the evidence was adequate to demonstrate that TMS was as good, or better, than usual care (i.e. general supportive psychotherapy with or without continued use of antidepressant medication). CEPAC also voted 9 to 6 that the evidence to support the use of TMS was adequate to demonstrate equivalent or superior outcomes to ECT. CEPAC then reviewed the budget impact and cost-effectiveness of TMS and the majority voted that, at current Medicare reimbursement rates, the use of TMS represents “reasonable value” when compared to usual care and a “low value” when compared to ECT.
“Our second public meeting of CEPAC addressed an area of great interest to the mental health community – patients who continue to have depressive symptoms after several failed treatment attempts,” stated Steven D. Pearson, MD, MSc, President of ICER. “Through the AHRQ report and our supplemental analyses, CEPAC was able to review the current state of the evidence for established and emerging techniques aimed at providing relief for this patient population. The members of CEPAC continue to provide policymakers, clinicians and patients with an objective voice on the current state of the scientific evidence for new and emerging interventions.”
The final meeting report includes supplementary analyses to augment the review of nonpharmacologic interventions for treatment-resistant depression in adults produced by AHRQ. The report also reviews the results of the votes taken by CEPAC on the adequacy of evidence to demonstrate the comparative clinical effectiveness and value of different approaches to treatment-resistant depression. The report concludes with key policy considerations from CEPAC to help guide researchers, providers, and payers to generate and apply evidence in ways that will improve the quality and value of psychiatric services across New England.
ICER is currently accepting nominations for the second iteration of CEPAC, which is slated to next meet in June 2012; nominations and applications are being accepted at www.icer-review.org. Over the coming weeks, the CEPAC website – cepac.icer-review.org – will have the latest information about the next topic for adaptation and meeting location.
CEPAC is a regional body whose goal is to provide objective, independent guidance on the application of medical evidence to clinical practice and payer policy decisions across New England. Supported by a federal grant from the Agency for Healthcare Research and Quality (AHRQ), and with backing from a consortium of New England state health policy leaders, CEPAC holds public meetings to consider evidence reviews of medical tests and treatments and provide judgments regarding how the evidence can best be used across New England to improve the quality and value of health care services. CEPAC consists of practicing physicians with experience in evaluating and using evidence in the practice of healthcare, as well as patient/public members with experience in health policy, patient advocacy and public health. ICER is managing the day-to-day operations of CEPAC as part of its federally funded RAPiD (Regional Adaptation for Payer Policy Decisions) initiative meant to develop and test new ways to adapt federal evidence reviews to improve their usefulness for patients, clinicians, and payers. A list of CEPAC members, and other information about the project, is available online at cepac.icer-review.org.
The Institute for Clinical and Economic Review (ICER), based at the Massachusetts General Hospital’s Institute for Technology Assessment (ITA) and an affiliate of Harvard Medical School, provides independent evaluation of the clinical effectiveness and comparative value of new and emerging technologies. Structured as a fully transparent organization, ICER seeks to achieve its ultimate mission of informing public policy and spurring innovation in the use of evidence to improve the value of health care for all. For more information, please visit www.icer-review.org.