Cost-utility analysis of transcranial direct current stimulation (tDCS) in non-treatment-resistant depression: the DISCO randomised controlled study protocol

Anne Sauvaget, Lydie Lagalice, Solène Schirr-Bonnans, Christelle Volteau, Morgane Péré, Cécile Dert, Annabelle Rivalland, Fabienne Tessier, Adeline Lepage, Agathe Tostivint, Thibault Deschamps, Véronique Thomas-Ollivier, Alison Robin, Noémie Pineau, Clémence Cabelguen, Nicolas Bukowski, Marie Guitteny, Auxane Beslot, Luc Simons, Hugopsy Network, Jean-Marie Vanelle, Giordano D'Urso, Samuel Bulteau, Valéry-Pierre Riche, DISCO investigators group, Bénédicte Gohier, Marine Rozet, Djamila Bennabi, Emmanuel Haffen, Christophe Daudet, Ludovic Samalin, Pierre-Michel Llorca, Benoît Trojak, Jean-Christophe Chauvet-Gélinier, Emmanuel Poulet, Charline Magnin, Stéphane Mouchabac, Ghina Harika Germaneau, Nemat Jaafari, Dominique Drapier, Jean-Marie Batail, Maud Rotharmel, Caroline Berjamin, Wissam El Hage, Thomas Desmidt, Anne Sauvaget, Lydie Lagalice, Solène Schirr-Bonnans, Christelle Volteau, Morgane Péré, Cécile Dert, Annabelle Rivalland, Fabienne Tessier, Adeline Lepage, Agathe Tostivint, Thibault Deschamps, Véronique Thomas-Ollivier, Alison Robin, Noémie Pineau, Clémence Cabelguen, Nicolas Bukowski, Marie Guitteny, Auxane Beslot, Luc Simons, Hugopsy Network, Jean-Marie Vanelle, Giordano D'Urso, Samuel Bulteau, Valéry-Pierre Riche, DISCO investigators group, Bénédicte Gohier, Marine Rozet, Djamila Bennabi, Emmanuel Haffen, Christophe Daudet, Ludovic Samalin, Pierre-Michel Llorca, Benoît Trojak, Jean-Christophe Chauvet-Gélinier, Emmanuel Poulet, Charline Magnin, Stéphane Mouchabac, Ghina Harika Germaneau, Nemat Jaafari, Dominique Drapier, Jean-Marie Batail, Maud Rotharmel, Caroline Berjamin, Wissam El Hage, Thomas Desmidt

Abstract

Introduction: Depression is among the most widespread psychiatric disorders in France. Psychiatric disorders are associated with considerable social costs, amounting to €22.6 billion for treatment and psychotropic medication in 2011. Treatment as usual (TAU), mainly consisting of pharmacotherapy and psychotherapy, is effective for only a third of patients and in most cases fails to prevent treatment resistance and chronicity. Transcranial direct current stimulation (tDCS) consists in a non-invasive and painless application of low-intensity electric current to the cerebral cortex through the scalp. Having proved effective in depressed patients, it could be used in combination with TAU to great advantage. The objective is to compare, for the first time ever, the cost-utility of tDCS-TAU and of TAU alone for the treatment of a depressive episode that has been refractory to one or two drug treatments.

Methods and analysis: This paper, based on the DISCO study protocol, focuses on the design of a prospective, randomised, controlled, open-label multicentre economic study to be conducted in France. It will include 214 patients with unipolar or bipolar depression, assigning them to two parallel arms: group A (tDCS-TAU) and group B (TAU alone). The primary outcome is the incremental cost-effectiveness ratio, that is, the ratio of the difference in cost between each strategy to the difference in their effects. Their effects will be expressed as numbers of quality-adjusted life-years, determined through administration of the EuroQol Five-Dimension questionnaire over a 12-month period to patients (EQ-5D-5L). Expected benefits are the reduction of treatment resistance and suicidal ideation as well as social and professional costs of depression. Should depression-related costs fall significantly, tDCS might be considered an efficient treatment for depression.

Ethics and dissemination: This protocol has been approved by a French ethics committee, the CPP--Est IV (Comité de Protection des Personnes-Strasbourg). Data are to be published in peer-reviewed medical journals.

Trial registration number: RCB 2018-A00474-51; NCT03758105.

Keywords: cost-utility; depression & mood disorders; quality of life; study protocol; tDCS; treatment.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Design of DISCO protocol. Dn, day n; Mn, month n; tDCS, transcranial direct current stimulation; TAU, treatment as usual.

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