- Special Pages
By Julie Appleby
Christine Curtis of Sterling, Va., says she is a “happy mom” again, crediting her recovery from debilitating depression to an expensive treatment that sends magnetic pulses into the brain.
“I can’t put a price on it,” said Curtis, 36, who said she feels better than she has in a decade after completing 30 days of the procedure, called repetitive transcranial magnetic stimulation, or rTMS.
An increasing number of psychiatrists and hospitals — as well as entrepreneurs opening rTMS centers around the country — are betting that there are millions of people like Curtis, discouraged by depression treatments that have proved unsuccessful and willing to pony up thousands of dollars for the possibility of relief. The treatment, which has been approved by the Food and Drug Administration, is covered by Medicare in five states, but few private insurers pay for it routinely.
While rTMS has ardent supporters, its effectiveness is still debated, and there is little evidence showing how long the results last. The technique has been shown to work better than a placebo, but the proportion of patients who show complete relief ranges widely, from as few as 10 percent to as many as 57 percent, according to various studies.
The debate has huge implications, not just for many of the 14 million Americans who suffer from major depression every year but also for businesses eyeing a potentially lucrative market and insurers weighing whether to cover it.
About half of those 14 million Americans seek relief through psychotherapy and prescription drug treatment, according to an evaluation by the federal Agency for Healthcare Research and Quality. But studies show that antidepressants provide complete cessation of symptoms only about a third of the time. Magnetic stimulation is aimed at patients with such “treatment-resistant depression.”
Supporters say rTMS is worth the cost — between $6,000 and $12,000 for the four-to-six-week treatment — because it enables people such as Curtis to resume productive lives.
Skeptics question the price tag in light of uncertain benefits.
“The majority of studies that evaluated rTMS failed to find evidence of an enduring treatment effect after the initial response . . . and some . . . failed to find any significant treatment effect,” concluded Health Plan of Nevada, a UnitedHealthcare insurer, which rejected coverage in March.
With the nation’s health-care spending expected to top $2.7 trillion this year, the battle over paying for rTMS demonstrates why it is so difficult to rein in health-care costs. New technology is generally allowed into the market after studies show it is reasonably safe and more effective than placebos. But that’s not the same as showing it works better than current approaches.
Experts differ over whether it’s smart to cover new techniques if they haven’t proved superior to established methods. And they can also disagree over the medical research itself: Was a study done well? Were there enough patients enrolled? Did it ask the right questions? Insurers often call for more research, while doctors and patients — many desperate for help — warn against delay. And costs are rarely discussed publicly.
In December, when Curtis first had a magnetic coil placed on her scalp while a $70,000 machine sent pulses into part of her brain, she had already spent a decade trying seven different prescription medications in her battle with depression.
Getting no relief but gaining weight and feeling sluggish and “out of it” because of the drugs’ side effects, she eagerly agreed to the month-long series of five-day-a-week treatments. Most patients have between four and six weeks of near daily sessions.
Curtis’ psychiatrist, Niku Singh, who is also the medical director at TMS NeuroHealth, suggested that she try the procedure. “I was all for it,” said Curtis, whose insurance did not cover the treatment. “It’s a matter of nothing else had worked, so what did I have to lose?”
As the very first patient treated at the Tysons Corner, Va., facility, which opened in December, Curtis paid only $3,000 because the center needed a test patient to meet the requirements of the device manufacturer. The fee is generally about $10,000, but officials say they work with patients who can’t afford that. Founders of the center compare rTMS’ potential to that of the now-ubiquitous laser eye clinics; they aim to open a chain of centers nationally that will take walk-ins and accept referrals from physicians. Walk-in patients without a doctor referral would be screened by the center’s medical director to determine if they are in fact appropriate candidates for rTMS treatment.
“We looked at the Lasik model and said, ‘Can we do this with depression? Can we do this with TMS?’” said Bill Leonard, president of the company.
During a treatment, a patient sits in a chair like one in a dentist’s office while an electromagnetic coil is placed against her head. The machine sends four seconds of magnetic pulses into the brain in 26-second intervals, making a woodpecker-like tapping noise. The whole procedure takes about 40 minutes and is monitored by a technician. Patients say it does not hurt. Studies have shown that side effects are few and generally minor, such as headaches and scalp irritations.
Singh said rTMS works by having the pulses stimulate a region of the brain that helps control mood; researchers say the pulses help depression by activating the release of neurotransmitters such as serotonin, norepinephrine and dopamine. WP-BLOOMBERG