I am a member of the Coding and Reimbursement
Committee of the American Association of
Neurosurgeons and Congress of Neurosurgeons and
I strongly support a policy of full Medicare
coverage for vagal nerve stimulation for the
treatment of treatment resistant depression.
Vagal nerve stimulation (VNS) has proven to be a
very effective and useful procedure in the
treatment of intractable epilepsy and I feel
that it will be shown to be just as effective
and useful in the treatment of resistant
depression (TRD).

Since vagal nerve stimulation for epilepsy was
approved by the FDA, thousands of patients have
undergone surgery for implantation of this
device. It is widely recognized by the
neurologists who care for these patients after
surgery that most of the patients who also had
depression showed a marked improvement in their
mood, independent of any improvement in their
seizures. Therefore to judge the effectiveness
of this procedure for TRD, I feel that CMS needs
to obtain the opinions of neurologists who
routinely manage individuals who have VNS
implants as well as psychiatrists who have
experience with VNS.

I feel that the published studies on the
effectiveness of VNS for TRD demonstrate an
efficacy greater or equal to the effect of
additional medication. Admittedly these studies
for the most part have been sponsored by the
company that makes the device. Nevertheless,
these studies are quality studies and cannot be
ignored. If CMS were to make a national
coverage decision against VNS for TRD, then
future studies would be extremely difficult.

Finally, one must measure the cost of VNS
surgery against the overall management costs for
individuals with TRD. Payors such as CMS can
easily measure the total medical expenses per
year for individual patients before and after
VNS surgery. I am not aware of any published
data about this but we are confident that as it
has been shown with epilepsy surgery, it will be
shown that VNS surgery will actually lower the
total medical expenses in individuals with TRD
over time.

I therefore hope that CMS will cover vagal nerve
stimulation for treatment resistant depression.