The repetitive transcranial magnetic stimulation (rTMS) is not reimbursed in the majority of countries. The reason for its non-inclusion in the benefit catalogue is either that it has not been assessed or that the evidence is insufficient to issue a recommendation.
European Network for Health Technology Assessment (EUnetHTA) released report of rapid assessment of rTMS for treatment-resistant major depression using the HTA Core Model. EUnetHTA aimed to analyze efficacy and safety of rTMS in adult patients with treatment-resistant major depression. The analysis only included CE-marked rTMS devices.
The body of evidence indicates that rTMS is generally safe and well-tolerated. rTMS had a small short-term effect for improving depression in comparison with sham, but follow-up studies did not show that the small effect will continue for longer periods. The current evidence is not sufficient to prove if rTMS is as effective and safe as electroconvulsive therapy, since no significant differences in remission and response rates were found, and studies showed high heterogeneity at a low total sample size. However, rTMS patients had less, and not clinically relevant decreases in depression scores as compared to ECT patients. No serious safety concerns were observed.
Due to the low quality of evidence, new study results would potentially influence the effect estimate considerably. Additional research is needed to support the findings with high-quality evidence.
Read full report here.