Estimating the potential savings with vagus nerve stimulation
for treatment-resistant depression: a payer perspective.
Washington State University College of
Pharmacy, Spokane, WA, USA.
OBJECTIVE:
To provide a formula estimating potential reductions in healthcare
utilization costs with adjunctive vagus nerve stimulation (VNS Therapy)
in treatment-resistant depression (TRD). METHODS: This
payer-perspective formula incorporates costs of treatment as usual for
TRD patients from a published analysis of the MarketScan private payer
claims database and the 2004 Medicare 5% standard analytic file.
Estimated remission and response rates are from the published VNS pilot
and pivotal studies. Costs were converted to 2008 US dollars per the US
Bureau of Labor Statistics medical care costs, consumer price index.
Device and implantation costs were calculated at $28 336. RESULTS: From
the MarketScan and pooled outcomes data (VNS pilot and pivotal
studies), potential per patient savings (hospitalization directly and
indirectly related to depression) was $2974 at 5 years of device life,
$23 539 at 8 years (moderate cost reduction scenario); $12 914 at 5
years, $40 935 at 8 years (optimistic scenario). Corresponding
break-even device life was 4.57 and 3.62 years, respectively. From the
Medicare file and pooled outcomes, potential per patient savings
(inpatient and outpatient directly and indirectly related to
depression) was $8358 at 5 years of device life, $32 385 at 8 years
(moderate scenario); $19 837 at 5 years, $52 473 at 8 years (optimistic
scenario). Corresponding break-even device life was 3.96 and 3.18
years, respectively. CONCLUSIONS: The formula allows an evaluation of
expected reductions in healthcare costs as a function of input cost
variables, efficacy rates, and benefit scenarios. Cited costs differ
relative to care settings, diagnostic principles, and procedural
volume. This formula can help assess moderate-to-longer-term economic
benefits of VNS for a particular institution. Results suggested that
potential reductions in healthcare costs with VNS for TRD may be
substantial. Break-even device life for the scenarios presented ranges
between 2.3 and 5.7 years.
PMID: 18786301 [PubMed - as supplied by publisher]