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We examined the cost\u2010effectiveness of ECT and TMS in MDD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A decision\u2010analytic model was developed to determine total costs, quality\u2010adjusted life\u2010years (QALYs) and incremental cost\u2010effectiveness ratios (ICERs) for 10 strategies. Each strategy comprised four treatment lines with ECT and TMS incorporated as second, third, or fourth line. A scenario analysis that explored the cost\u2010effectiveness of maintenance approach by continuing ECT and TMS after acute treatment was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the base case, fourth\u2010line TMS after three preceding trials of antidepressants was least costly at US$ 5523 yielding 1.424 QALYs. Compared with this strategy, fourth\u2010line ECT and third\u2010line TMS followed by ECT were cost\u2010effective with ICERs of US$ 7601 per QALY gained and US$ 11\u2009388 per QALY gained, respectively. In the scenario analysis where continuation treatments of ECT and TMS were provided, third\u2010line TMS followed by ECT was cost\u2010effective, with an ICER of US$ 17\u2009198 per QALY gained. Effectiveness of ECT and cost of managing severe depression were influential parameters affecting the cost\u2010effectiveness results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In acute treatment of MDD, fourth\u2010line ECT was the most cost\u2010effective strategy. In maintenance treatment, the strategy that incorporated third\u2010line TMS and fourth\u2010line ECT was cost\u2010effective. The overall findings confirmed the value of neurostimulation therapies which should be offered early in the process of managing depression.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eip.13091","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T23:09:36Z","timestamp":1606777776000},"page":"1531-1541","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Neurostimulation therapies in major depressive disorder: A decision\u2010analytic model"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4901-2649","authenticated-orcid":false,"given":"Monica","family":"Teng","sequence":"first","affiliation":[{"name":"Group Health Informatics National Healthcare Group Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ai Leng","family":"Khoo","sequence":"additional","affiliation":[{"name":"Group Health Informatics National Healthcare Group Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying Jiao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Group Health Informatics National Healthcare Group Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edimansyah","family":"Abdin","sequence":"additional","affiliation":[{"name":"Research Division Institute of Mental Health Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yee Ming","family":"Mok","sequence":"additional","affiliation":[{"name":"Department of Mood and Anxiety Institute of Mental Health Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boon Peng","family":"Lim","sequence":"additional","affiliation":[{"name":"Group Health Informatics National Healthcare Group Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phern Chern","family":"Tor","sequence":"additional","affiliation":[{"name":"Research Division Institute of Mental Health Singapore Singapore"},{"name":"Duke\u2010NUS Graduate Medical School Singapore Singapore"},{"name":"National University of Singapore Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0643-4830"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12878"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198526629.001.0001","volume-title":"Decision modelling for health economic evaluation. 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