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35 rTMS Medicare Subsidised Sessions for Eligible Adult Patients

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35 rTMS Medicare Subsidised Sessions for Eligible Adult Patients
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SupeNintendoChalmers on 16/09/2021 - 13:51 health.gov.au (3831 clicks)
Last edited 16/09/2021 - 18:57 by 1 other user

This is absolutely HUGE news. Transcranial Magnetic Stimulation (TMS) is a proven therapy used to treat depression. Normally it costs ~$160-$200 per session, now it will be covered by Medicare.

Full government spiel below

Prioritising Mental Health – Supporting access to new therapy for major depressive disorder

The Australian Government is investing $288.5 million to introduce a new service for Repetitive Transcranial Magnetic Stimulation (rTMS) therapy to the Medicare Benefits Schedule (MBS) following recommendations from the independent Medical Services Advisory Committee (MSAC).

This investment will ensure Australians battling major depressive disorders who are non-responsive to antidepressant medications can access this innovative Medicare-subsidised therapy. This is part of a record $2.3 billion whole-of-government Mental Health and Suicide Prevention Plan.

rTMS is a form of localised brain stimulation therapy used to target the region of the brain involved in mood regulation and depression. It has been found to be effective in treating major depressive disorders and provides a more non-invasive option for medication resistant patients compared to the alternative – electroconvulsive therapy.

Eligible adult patients who have tried at least two different classes of antidepressant medicines but remain unwell will be able to access Medicare-subsidised rTMS therapy.

Why is this important?

Evidence shows that rTMS therapy is safe, well tolerated, and effective in treating major depressive disorders. Previously, rTMS therapy has been prohibitively expensive for Australians suffering major depressive illness. The addition of rTMS to the MBS aligns with the Australian Government’s commitment to ensure Australians are able to access affordable and safe healthcare that reflects contemporary clinical practice.

These investments are in response the National Suicide Prevention Adviser’s Final Advice and the Productivity Commission's Inquiry into Mental Health.

Who will benefit?

It is estimated that in the coming 4 years, some 90,000 Australians will be eligible for MBS subsidised rTMS therapy.

They will benefit from an initial course of up to 35 rTMS treatment sessions, with one re-treatment course of up to 15 sessions if they have relapsed after responding to the initial treatment course.

How much will this cost?

The Australian Government is investing $288.5 million* over 4 years from 1 November 2021 to 2024–25.

* This investment also appears in the Guaranteeing Medicare – MBS review and new inclusions factsheet

Health & Beauty Medicare Repetitive Transcranial Magnetic Stimulation

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Comments

            • EBC on 16/09/2021 - 17:10
              +3

              @pompompom: From the most recent network meta-analysis by Papadimitropoulou et al.:

              "At 6 weeks after baseline, rTMS (80–120%) showed the highest remission rates and ranked first among all competing pharmacological interventions (OR 8.58 95% CrI 1.15, 112.55)."

              So not only does it work, it appears to work better than all competing interventions at achieving remission.

              • pompompom on 16/09/2021 - 17:13
                +1

                @EBC: Hey man. If from a set of 100%, 120% percent showed remission rates I'd be concerned.

                • EBC on 16/09/2021 - 17:16
                  +2

                  @pompompom: Cool, tell me more about how informed you are.

                  In case you didn't know though, the 80-120% refers to the intensity of the treatment used and nothing to do with the efficacy of the treatment. The measure of efficacy here is the OR (odds ratio) which suggests it is ~9x more effective than sham treatment.

                • Gehirn on 16/09/2021 - 17:17
                  +2

                  @pompompom: That percentage isn't to do with the amount of people.

        • EBC on 16/09/2021 - 17:03
          +2

          Which trials are you referring to because every systematic review I have seen has shown a clear positive effect? Based on the forest plots in these reviews some studies have shown no difference but the pooling of data demonstrates a positive effect.

          No randomised trial since 2010 at least that I can find has shown worse performance than sham treatment.

          For people who want the take away from the paper in "Australian & New Zealand Journal of Psychiatry", here are the concluding paragraphs.

          "Clearly, rTMS [Repetitive transcranial magnetic stimulation] therapy for depression has been evaluated across a wide range of research studies commencing with a series of small clinical trials and progressing to larger multisite trials. The research evidence supporting its efficacy has been summarised in numerous meta-analyses and subsequently in umbrella reviews and network meta-analyses. Individual meta-analyses and the recent umbrella review (Razza et al., 2020) have clearly confirmed that rTMS is an effective treatment for patients with MDD [major depressive disorder] and is safe and well tolerated. Network meta-analysis have confirmed that there are several forms of rTMS that are effective and importantly that it has comparable, if not superior, efficacy when compared to other interventions for patients with TRD [treatment resistant depression].

          Although rTMS is by no means a perfect treatment and ongoing developmental work is required to enhance its efficacy and efficiency of clinical delivery, we think that the evidence presented above, collated progressively over the last 25 years of research, clearly shows that it has a meaningful and substantial place now in the management of patients with TRD. It should be made available to and be presented to patients as an alternative treatment option when there has been insufficient clinical benefit from initial trials of antidepressant medication (see Figure 2 and Table 1). The evidence for, and place of, rTMS in treatment should be reflected in clinical practice guidelines, clinical service provision, and the education and training of psychiatric clinicians. The comprehensive research conducted in the development of rTMS by groups all around the world has convincingly established that it is an effective and valuable treatment. The focus now should be on how to make rTMS most appropriately available and accessible to as wide a range of suitable patients as possible."

          • yoke2018 on 21/10/2021 - 21:30

            @EBC: No offence, but only because there is lots of jargon in your response and in the quoted passage (e.g., “forest plots”, “meta-analyses,” “Network meta-analysis,” “randomised”) doesn’t make it any more plausible. The quoted conclusion only outlines and doesn’t explain (and rightly so). But, it is also not a very impressive conclusion when referencing its results. And that is precisely because of this sentence: “…there are several forms of rTMS that are effective and importantly that it has comparable, if not superior, efficacy when compared to other interventions…”

            “…effective and importantly that it has comparable, if not superior…”

            Firstly, what does “effective” mean and how is it defined/measured. Does low effect size still count as effective? Again, what does “superior” mean? Is it considered superior even if it is slightly above comparable? What degrees of “superior” effect sizes are there and how much of each degree is involved when stating “superior?”

            Put simply, how effective was the “effective” treatment (low, moderate, strong) and how “superior” was the effect size (low, moderate, strong)? The “…comparable, if not superior…” suggests that it was only ever mildly superior.

            (A true scientist:
            - always remains skeptical, never just skips to the conclusions of studies,
            - always advises others to think critically to never accept seemingly impressive results/conclusions at face value
            - always excruciatingly dissects the research methodologies [methods is the most important part of any scientific journal article],
            - challenges the findings of every systematic review and meta-analysis [sometimes through philosophy of knowledge, logic, or science])

            • EBC on 21/10/2021 - 22:09
              +1

              @yoke2018: Do you want access to the paper? Happy to send it to you if you do. I posted the conclusion because it was an easy part to post that had the take away from the paper. The paper has the data which would answer most of your questions about the magnitude of the effect and superiority.

              I literally am a "true scientist", and do this for a living (infectious diseases not mental health mind you) so I apologise if it felt jargon heavy. I am in the midst of writing a series of systematic reviews right now so it just was the writing style I am used to at the moment.

              All that said, I didn't take this or any of the research I read on this at face value. Of course there is more research to do, it is rare that we reach a point where there is nothing left to research. But challenging the data doesn't mean never acting on it. Data shows that this is a valid treatment. If further research refines this, or better determines how and when to implement it, that is great and those changes should be integrated into clinical care. If it shows it is actually worthless (I would be very surprised based on the data), then we should absolutely discard it and remove it from the MBS. At the moment though, our best data says it is not only effective but that it is worth being Medicare reimbursed by an independent panel.

              • yoke2018 on 22/10/2021 - 14:49
                +1

                @EBC: Thanks mate for understanding, great that two likeminded researchers can agree! It’s a beautiful harmony whenever I come across it. You summed it up succinctly and perfectly! Yes, applied scientific research that is both valid and effective should move into the community to benefit people and then refine it upon more added research.

                I’m just extremely skeptical regarding science because there are many environmental forces (institutional, financial, biases) that influence depth and scope of investigation, research methodologies, comparisons, publication, and review studies. But that’s a different discussion.

                And I get where you’re coming from in that one can get stuck in a certain writing style, hell, you should see Peter Fitzsimmons’ writing style, he’s so hell bent on colloquialism because he’s so stuck in it as that’s the way he talks lol.

                Great time to be in the infectious diseases field and many more lay people are trying to learn more about it too which is great, and AU has—historically—among the world’s best infectious diseases scientists and it’s a great tradition that we have built on. Kudos mate and keep it up.

    • Clear on 16/09/2021 - 16:35
      +2

      Except it can't be pseudo science when there's evidence it works. On another topic what about the COVID vaccines?

    • AustriaBargain on 16/09/2021 - 17:46
      +3

      It's 2021, we're going to come up with some pretty sci-fi treatments and some of them are actually going to work. By all accounts, this one seems to work. Maybe in 2041 we will have machines that can zap depression out of you reliably, but for now a machine that passes the medicare cost/benefit analysis is pretty amazing imo. Each state in Australia clearly has absolutely no idea how to treat and manage mental illness so we are going to need a lot of machines like this.

  • hashash on 16/09/2021 - 16:31

    How do I get this TMS Treatment?

    What is the best, fastest and cheapest way to smart TMS treatment immediately???

  • ChadHominem on 16/09/2021 - 16:39

    Probably the best overall treatment we currently have

  • AJAJAJ on 16/09/2021 - 16:47

    i am Depressed …..Suddenly Pineapples…………………..

  • anglais on 16/09/2021 - 17:12
    +2

    As per AHPRA guidelines you can't encourage the indiscriminate or unnecessary use of regulated health services. Promoting this as a deal might be cutting it fine. That said it is a good way to inform people who could benefit from this new rebate.

    • Gehirn on 16/09/2021 - 17:15

      Pretty sure you need a referral at TMS clinics though so your doctor writing one taking your health history into account takes care of that.

      • assailantsky on 16/09/2021 - 17:19
        +1

        you need a referral

        Isn't this the same with any regulated drugs that does fall under AHPRA guidelines?

  • Feeblely on 16/09/2021 - 17:52

    Isnt this cheaper and better than talk therapy? Why not just make it the first option available for some :(

    • Koffee on 16/09/2021 - 17:56

      It's not cheaper for medicare - between the psychiatrist fees ($250~) and the fact sessions run at like $200 each, they can put you through 10 sessions of talk therapy a year and only give you $75 back a pop and be up $1200~ .

      • AJAJAJ on 16/09/2021 - 18:10

        With half of that price, you can sit with mates in a pub over a beer and will have plenty of talk…:)…Cant beat that

        • MarcusJones on 16/09/2021 - 18:27

          Except as most guys will attest as a bloke you can “only” talk to other guys about sports, tech, games, booze and women.

          Plus for the last couple of months we aren’t allowed to visit mates or go to a pub.

          But I agree with the premise of your point…

  • jaimex2 on 16/09/2021 - 18:17
    -2

    What can't be solved with helplines can be solved with magnets and shortly prescribed pills.

    I can't wait to leave this dumpster fire of a country and shred my passport / citizenship.

    • yoke2018 on 21/10/2021 - 20:47

      Lol and go where exactly that’s better? Sweden? Denmark? Norway? Switzerland? UK? US? Fiji? Australia is very good despite a lot of other negative areas…

  • Flick133 on 16/09/2021 - 18:25
    +20

    The negative comments on here about a serious disorder that accounts for countless people taking their life every year is absolutely disgusting. Share the joy with the people who have been unable to have this treatment due to the excessive cost. If you can’t do that then shut the (profanity) up

    • SupeNintendoChalmers on 16/09/2021 - 18:25
      +1

      Preach

    • steve-oz on 16/09/2021 - 21:13

      TIL there are swarms of bitter small minded people on OzBargain. Sad really.

      • yoke2018 on 21/10/2021 - 20:49

        Only til the long-term ;)

  • Clear on 16/09/2021 - 18:30
    +1

    Imagine being so triggered by a post like this. It's not good for your mental health to be so distressed by a single post.

  • Jugganautx on 16/09/2021 - 18:45
    -3

    Should have used that money to bring Australia into the future with a proper NBN.

  • silenthillrocks on 16/09/2021 - 19:15
    +1

    It's not free you pay via taxes

  • ndro777 on 16/09/2021 - 19:31
    -1

    I’m voting positive, just cause.

  • funnysht on 16/09/2021 - 19:32

    Try meditation. Free and clinically proven. But I am all for this too

  • PvsNP on 16/09/2021 - 20:12

    Wonder how much is it for the machine itself?!

    • digitalbath on 16/09/2021 - 22:00

      Our machines at work cost about $60k each, we have 3. Our old ones were only $30kish I think.
      It is a massive cash cow for the private psychiatric hospitals.
      If I had the cash I'd buy a machine and set up a clinic. Not as simple as just getting a machine I know, but would be a good earner in this day and age.

      • Hintswen on 17/09/2021 - 21:10

        I'm surprised they are that cheap! For medical equipment I mean, I'd expect them to cost a lot more.

  • MatrixM on 16/09/2021 - 22:21

    Too bad I have to go through two classes of meds before this is available, but I understand why they make it that way. Nevertheless, this is an absolutely wonderful thing for Australia

  • missLJ on 17/09/2021 - 08:36

    That is awesome news! I hope people get the best benefits from it now it's available to them.

  • life is suffering on 17/09/2021 - 09:42
    +2

    I'm glad I'm paying for this for people who need it. Tax dollars paid by the people for the people.

  • krunchymoses on 20/09/2021 - 12:26
    +1

    Thanks OP. I am recommending this right now to a mate that isn't doing well (and regularly isn't doing well). It's just one more thing people can try. Raising awareness of this is genuinely helpful and people that say otherwise can get in the bin.

  • yoke2018 on 21/10/2021 - 20:23

    Great initiative imo; can only help than harm (it’s literally very safe).

    Not related directly to TMS, but interestingly brain training or biofeedback (basically modifying brain waves in very specific ways) can also help with depression symptoms if no one has heard about or considered it. It’s relatively new and uncommon in Australia. My wife did it for about 8 sessions and saw some impressive improvements. I only know of one (health)psychologist in Sydney (Burwood) and the guy even bulk-billed (which normally costs thousands) I can provide his professional details if you pm me but can’t guarantee if he sees new patients (I’m not associated, just trying to help).

    Also, what may be helpful (if sufferers haven’t considered) is a pharmacogenomic DNA drug profile test from mydna.life (mouth swap, Australian based, quick results in a week, pretty cheap at $89–I’m not associated with them) and it gives your psychiatrist (unfortunately not sent directly to you) a genetic profile/report of how your body/metabolism reacts to certain classes of medications (like antidepressants) so that your psychiatrist can better tailor medication doses and combinations for you.

    Also, if you’ve tried all the antidepressant classes, as well as some anticonvulsants, benzos (not recommended), and even antipsychotics, and brain training and TMS alongside all the psychological CBT/DBT/ACT/MBSR/MBCT / schema / psychoanalytic / grief / existential / narrative / art / family / biblio etc psychotherapies that you can engage with, yet still not seeing dramatic improvements; then you could consider (with your psychiatrist) some more unorthodox options such as stimulant medications (e.g., lisdexamphetamine [Vyvanse] is approved by TGA to treat both ADHD and Binge Eating Disorder, both of which depression commonly co-occurs).

    Hope any of the above helps and I can provide further info via here or pm (long sufferer of depression/anxiety and mental health professional).

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