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Linda Carpenter, an associate professor of psychiatry and human behavior at Brown University, who has conducted medical studies using rTMS for depressed patients, says the treatment is effective for some patients, possibly even better than simply trying another medication. But she says questions remain about how long the effects last and how often a patient should return for additional sessions.
"What's the range of booster treatments people need?" she asks. "Is it once a week, or every couple of years? There's a huge range in my clinical experience." Carpenter, a physician, says research has not found any safety issues for patients returning for additional treatments, but cost is a factor.
Uncertainty about its long-term effectiveness is why most insurers do not routinely cover rTMS. Medicare also has mainly rejected coverage, though in January, the administrator of the program's New England region became the first to approve it, citing the AHRQ report and an assessment from an independent regional advisory board.
That 19-member panel voted 10 to 5 last year that studies of the treatment showed it to be as good as or better than usual care for depression. Six of the 10 said it represented a "reasonable" value for its cost; four saw it as a low value. (The same panel voted 9 to 6 that rTMS's health benefit was equal to that of ECT.)
Even with limited insurance coverage, about 8,000 patients have had the treatment, and the number of treatment centers has doubled to a total of about 400 nationwide since 2010, according to reports by the device's maker. Centers include some big names, such as Johns Hopkins in Baltimore and the Mayo Clinic in Rochester, Minn.
Still, some are not convinced. "The initial treatment with rTMS is $12,000: That's a lot of generic Prozac or Effexor," which are cost-effective antidepressants with long track records, said Joel Rubinstein, associate medical director of Harvard Pilgrim HealthCare, an insurer that does not cover rTMS. "Managed care has an obligation to a population. You're shepherding a fixed amount of resources across a large population and trying to do it according to some sort of evidence-based system."
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Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.