Transcranial Direct Current Stimulation (tDCS) Cost-utility-analysis in Medical Care on Depressive Episode With One Drug Therapy Failure.

Depression Clinical Trial

— DISCO  

Official title:

Transcranial Direct Current Stimulation (tDCS) Cost-utility-analysis in Medical Care on Depressive Episode With One Drug Therapy Failure.

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03758105
• Other study ID #: RC17_0493
• Status: Active, not recruiting
• Phase: N/A
• Start date: February 4, 2019
• Est. completion date: November 11, 2023

Study information

• Verified date: February 2023
• Source: Nantes University Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to determine the transcranial direct current stimulation (tDCS) cost-utility in the depression therapy.

This is a 3 years medico-economics study with 1 year follow-up period involving patients with 1 or 2 depression treatment(s) failed.

Eligible subject will be randomized in 2 groups, usual care with tDCS cure (arm A) or only usual care (arm B).

Description:

Transcranial direct current stimulation is a non-invasive brain neuromodulation technique. tDCS can be a new therapy in depression.

This study focuses on tDCS cost-utility-analysis. Each patient is following during 12 months. Patients are randomized in 2 arms. Arm A usual care with tDCS cure or arm B usual care without tDCS.

Patient in arm A get a initial tDCS cure one week after randomization. If these patients are answering to the treatment, they can have a new cure in case of relapse. This new cure can start from the second month following initial treatment.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 214
• Est. completion date: November 11, 2023
• Est. primary completion date: November 11, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Depression according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) with 1 or 2 failed antidepressant treatments for the current episode.

• MADRS score superior or equal to 15.

• Patient agreeing to participate in the study

• Patient able to answer questionnaires and able to go at research center for follow-up visit.

• Patient with social insurance

Exclusion Criteria:

• Electroconvulsive therapy or repetitive transcranial magnetic stimulation for current depressive episode.

• Depressive episode with psychotic symptoms or mixed.

• Schizophrenia or addiction to another substance than nicotine

• Severe neurological disorder (like epilepsy, neurological affect, neurological disease)

• Severe and / or progressive somatic pathology (leave to the investigator judgment) preventing from participation in the study.

• tDCS specific contraindications (intracerebral metallic implant, pacemaker)

• Pregnancy or breast feeding.

• Woman of childbearing age without contraception (hormonal or with medical device).

• Participation in another interventional clinical trial

• legal protection

• Persons incarcerated or in obligation of treatment / medical treatment order.

Related Conditions & MeSH terms

• Depression

Intervention

Other:
• tDCS associated with usual care
A tDCS cure will be given to the group "tDCS", one week after their randomization. This will be done in association with usual care: medication and psychotherapy Parameters: Anodal stimulation on dorso-lateral prefrontal cortex left, 2mA current. Treatment will consist of 15 days with 30 minutes stimulation per day, 5 days a week for 3 weeks.
• Usual care
Medication and psychotherapy as prescribed in usual care

Locations

Country	Name	City	State
France	CHU d'Angers	Angers
France	Clinique Mirambeau	Anglet
France	CHRU de Besançon	Besançon
France	Chu Clermont Ferrand	Clermont-Ferrand
France	CHU de Dijon	Dijon
France	Chu de Lyon	Lyon
France	Nantes University Hospital	Nantes
France	Aphp Hopital Saint Antoine	Paris
France	CH Henri Laborit (Poitiers)	Poitiers
France	Centre hospitalier Guillaume Regnier Rennes	Rennes
France	CH du Rouvray - Rouen	Rouen
France	CHU de Tours / CHRU de Tours	Tours

Sponsors (1)

Lead Sponsor	Collaborator
Nantes University Hospital

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Cost-utility ratio, according to collective perspective of tDCS use in depression compared to usual care without active tDCS.	The utility will be measured by : Quality Adjusted Life Year (QALYs) as estimated from responses to the Euroqol-5 Dimensions (EQ-5D) health-related quality of life questionnaire. The questionnaire focuses on 5 dimensions: mobility, personal autonomy, current activities, pain/discomfort and anxiety/depression. For each of these dimensions, 5 answers are possible.; The costs will be measured by the addition of the following costs: Drugs dispensing via Health insurance database "National system of information of the French health insurance" (SNIIRAM), hospitalizations, work stoppages and care consumption collected in a declarative patient questionnaire.	12 months
Secondary	Budget impact analysis of spreading the most efficient strategy for using tDCS	Comparison of intervention costs on the study sample and projection of these costs over 5 years, from the health insurance and hospital perspectives	5 years
Secondary	Response rate	Response is defined as follows: decrease of the MADRS score by at least 50% compared to baseline score. MADRS stands for Montgomery-Asberg Depression Rating Scale. It is used to measure the severity of depressive episodes in patients with mood disorders. The questionnaire includes questions on the following symptoms 1. Apparent sadness 2. Reported sadness 3. Inner tension 4. Reduced sleep 5. Reduced appetite 6. Concentration difficulties 7. Lassitude 8. Inability to feel 9. Pessimistic thoughts 10. Suicidal thoughts and each item yields a score of 0 to 6. The overall score ranges from 0 to 60. A score from 0 to 6 being normal/symptom absent and a score >34 being severe depression.	at baseline, at the end of each tDCS cure (for Arm A patients) through study completion (12 months) and at 12 months for all patients
Secondary	Remission rate	Remission rate is defined as follows: MADRS score < 10 (see detailed description of MADRS in outcome 3)	12 months
Secondary	Relapse-free survival	Number of patients with no relapse. Relapse is defined as follows: MADRS = 20 (see detailed description of MADRS in outcome 3)	12 months
Secondary	MADRS score	MADRS score (see detailed description of MADRS in outcome 3)	At Baseline, one month, 2 months, 6 months and 12 months.
Secondary	Beck Depression Inventory (BDI) score	The BDI is 13-item multiple-choice self-report inventory, for measuring the severity of depression. The global score is an addition of each item's score and ranges from 0 (minimal depression) to 39 (severe depression).	At Baseline, one month, 2 months, 6 months and 12 months.
Secondary	Clinical Global Impression (CGI) score	The Clinical Global Impression (CGI) rating scales are measures of symptom severity, treatment response and the efficacy of treatments in treatment studies of patients with mental disorders. Each scale is rated from 0 to 7. 0 being the best level and 7 the worst level.	At Baseline, one month, 2 months, 6 months and 12 months.
Secondary	MOCA Score (Montreal Cognitive Assessment)	Thirty items assessing multiple cognitive domains are contained in the MoCA: short-term memory (5 points); visuospatial abilities via clock drawing (3 points), and a cube copy task (1 point); executive functioning via an adaptation of Trail Making Test Part B (1 point), phonemic fluency (1 point), and verbal abstraction (2 points); attention, concentration, and working memory via target detection (1 point), serial subtraction (3 points), digits forward (1 point), and digits backward (1 point); language via confrontation naming with low-familiarity animals (3 points), and repetition of complex sentences (2 points); and orientation to time and place (6 points)	At Baseline, one month, 2 months, 6 months and 12 months.
Secondary	Adverse events linked to the medical treatment for depression	Number and types of adverse events linked to the medical treatment for depression	12 months
Secondary	Rate of suicide attempts	number of suicide attempts per patient	12 months
Secondary	Rate of suicides	number of suicides	12 months
Secondary	Treatment(s) switch(es)	Number of treatment switches per patient	At Baseline, one month, 2 months, 6 months and 12 months.
Secondary	Treatment(s) dose increase	Number of drug(s) dose(s) increases prescribed to the patient	At Baseline, one month, 2 months, 6 months and 12 months.
Secondary	Treatments combination(s)	List of drugs (name) prescribed to the patient	at Baseline, one month, 2 months, 6 months and 12 months.
Secondary	Declarative drug compliance via the MARS (Medication Adherence Report Scale)	MARS is the Medication Adherence Report Scale, including 10 questions, the global score ranges from 0 to 10, 0 corresponds to the worst drug compliance and 10 to an excellent drug compliance	at baseline and at 12 months
Secondary	Declarative drug compliance via the CRS (Clinician Rating Scale)	CRS is the Clinician Rating Scale , including 7 questions, the global score ranges from 1 to 7, 7 being the worst level of drug compliance.	at baseline and at 12 months
Secondary	Total number of tDCS sessions	total number of tDCS sessions per patient	12 months
Secondary	Number of days between the successive tDCS cures	Number of days between end of tDCS cure X and beginning of cure X+1, for each patient	12 months
Secondary	Adverse events linked to tDCS	Number and types of adverse events linked to the tDCS	12 months
Secondary	Compliance with tDCS	number of missed sessions over the number of planned sessions, per patient	12 months
Secondary	Patient acceptability of the tDCS technique: Analog Visual Scale	Analog Visual Scale of acceptability of the tDCS completed by the patient, ranging from 0 to 10. 0 being "not acceptable" and 10 being "totally acceptable"	at the end of the first tDCS cure (up to one month)
Secondary	professional status	patient's professional status (active, unemployed, retired...)	At baseline
Secondary	Impact of the implementation of the tDCS on the organization of care	The organizational impact of the tDCS will be evaluated from the point of view of doctors, nurse and patients: staff, equipment, maintenance, location and mobilization time of these resources, using a specific questionnaire	12 months