Depression, Depressionen

How Much Does VNS Cost ?

How Much Does VNS Cost, Relative to Other Treatment Modalities?

In the United States, VNS delivered with the NCP System costs roughly $9200 for the generator and electrode. The surgical and hospital costs for the implantation surgery vary widely and are more difficult to quantify but are less expensive now with the recent trend toward outpatient surgery and local anesthesia. Typically the total charge for the NCP System plus implantation varies from $12,000 to $25,000 (B. Barrett, Cyberonics, personal communication, October 1999). Most federal and private insurance companies reimburse this procedure for treatment of refractory epilepsy. After implantation the cost of the device is minimal, as the battery lasts many years and there is no required maintenance. Adjustments of the VNS settings are done by treating neurologists in their office using the personal computer and attached programming wand.

If the initial open results in depression were confirmed in a double-blind study and FDA approval granted for VNS treatment of depression, the cost of VNS would compare to about $1000 for a year of a single antidepressant medication or $10.000 to $30.000 for an acute course of ECT followed by a year of maintenance ECT (Hu and Rush 1995; Olfson et al 1998); however, since VNS is continuous and a maintenance treatment modality, true cost comparisons should be made against maintenance therapies, and the relative cost of VNS improves with each year of continued use and compares favorably to maintenance ECT, as most of the costs are associated with the initial device purchase and implantation.

Unfortunately, only a few epilepsy patients achieve full seizure remission and are able to reduce other antiepileptic medications. Most combine VNS with medications. Thus VNS, as now delivered, has not been shown to be a substitute for anticonvulsant medications. As the neuro scientific basis of VNS is better understood, there is hope that refinements of VNS settings might improve the clinical effects, with better cost savings on reductions of concomitant medications.

Rationale for Studying VNS in Mood Disorders

In addition to the neuroanatomic considerations, several additional lines of evidence provided the background for studying whether VNS might have antidepressant effects in treatment-resistant depression, culminating in the first implant for this indication in July 1998 at the Medical University of South Carolina in Charleston (Rush et al 2000), a decade after the first human epilepsy implant (Penry and Dean 1990). These hints were 1) mood effects of VNS observed in patients with epilepsy, 2) evidence by positron emission tomography (PET) scans that VNS affects the metabolism (and therefore the function) of important limbic structures, 3) the role of anticonvulsant medications in mood disorders, and 4) neurochemical studies in both animals and humans revealing that VNS alters concentrations of monoamines within the central nervous system (CNS).