Class Name Item Non-selective monoamine reuptake inhibitors Imipramine Hydrochloride 2420J, 2421K Hydrochloride Clomipramine 1561E Amitriptyline Hydrochloride 2417F, 2418G, 2439W Doxepin Hydrochloride 1011F, 1012G, 1013H Dothiepin Hydrochloride 1358L Nortiptyline Hydrochloride 2522R, 2523T Selective serotonin reuptake inhibitors Citalopram Hydrobromide 8702B, 8703C Sertraline 2237R, 8836C, 8837D Fluoxetine 1434L, 8270G Fluovoxamine 8174F, 8512B Paroxetine 2242B, 9197C Escitalopram 8701Y, 8849R, 9432K, 9433L Monoamine oxidase inhibitors, non-selective Phenelzine Sulfate 2856H Tranylcypromine sulphate 2444P Monoamine oxidase type A inhibitors Moclobemide 1900B, 8003F Other antidepressants Mianserin Hydrochloride 1627P, 1628Q Mirtazapine 8513C, 8855C, 8856D, 8857E, 8883M, 9365X Reboxetine Mesilate 8583R Duloxetine Hydrochloride 9155W, 9156X Desvenlafaxine succinate 9366Y, 9367B Venlafaxine Hydrochloride 8301X, 8302Y, 8868R Lithium carbonate 3059B, 8290H There are a range of psychological therapies that are able to be claimed on the MBS. These specific focussed psychological strategies are: 1. Psycho-education including motivational interviewing 2. Cognitive-behavioural therapy (CBT) including:  Behavioural interventions o Behaviour modification o Exposure techniques o Activity scheduling  Cognitive interventions o Cognitive therapy 3. Relaxation strategies  Progressive muscle relaxation  Controlled breathing 4. Skills training
Figure 1 Management algorithm for patients with major depression Major depressive episode (based on DSM IV rating) Requiring rapid treatment due to psychosis or suicide risk? Yes ECT ± anti- depressants ± psychological therapies No Non-physical therapy† Anti-depressants ± psychological therapies Psychological therapies 1st and 2nd-line therapies Response No response/ partial response Considered to have anti-depressant treatment resistant depression Anti-depressants (3rd or subsequent line, augmented with other agents, or combination antidepressants) ± psychological therapies rTMS ± anti- depressants ± psychological therapies ECT ± anti- depressants ± psychological therapies 3rd and subsequent - line therapies No response/ partial response Response Relapse Remission Relapse Recovery Recurrence * = Different course of treatment. Patients considered to have treatment resistant depression are required to have at least two courses of failed antidepressant therapy † Physical therapies = ECT and rTMS No further treatment Maintenance treatment
Provider Setting in which Proportion Number of units of resource per Disaggregated unit cost of resource resource is provided of patients receiving resource relevant time horizon per patient receiving resource MBS nets* govt budget Private health insurer Patient cost ‐ Capital equipment ‐ Indirect costs (overhead facility costs) Facility Outpatient 100% 20 $14 $280 Facility Outpatient 100% 20 $17 $340 Resources provided in association with rTMS ‐ Follow-up Psychiatrist Outpatient 100% ‐ Repeat rTMS Allied health profession al or Outpatient 20% within 20 2 years ‐ Maintenance rTMS Allied health profession al or 10% 26 per annum Resources provided in the event of adverse event after proposed intervention (e.g. a seizure) ‐ Hospital stay Hospital Inpatient <2% Resources provided to identify eligible population for switched or augmented or combined antidepressants ‐ Psychiatric consultation Psychiatrist Outpatient TBD 1 ‐ General Practitioner consultation General Practitioner Outpatient TBD 1 Resources provided to deliver switched or augmented or combined antidepressants ‐ Antidepressant Pharmacist Outpatient 100% ‐ Augmentation Pharmacist Outpatient TBD Resources provided in association with switched or augmented or combined antidepressants (e.g, resources used to monitor or in follow-up, resources used in management of adverse events, resources used for treatment of down-stream conditions) ‐ Psychiatric consultation Psychiatrist Outpatient TBD 1 ‐ General Practitioner consultation General Practitioner Outpatient TBD 1 Resources provided to identify eligible population for psychotherapy ‐ GP Mental Health Treatment Plan General Practitioner Outpatient 100% 1 $69 - $129 $69 - $129 Resources provided in association with psychotherapy ‐ General Practitioner consultation General practitioner ≤10 per year ‐ Psychologist consultation TBD ≤10 per P
Simpson, KN, Welch, MJ, Kozel, FA, Demitrack, MA & Nahas, Z 2009, 'Cost-effectiveness of transcranial magnetic stimulation in the treatment of major depression: a health economics analysis', Adv Ther, vol. 26, no. 3, Mar, pp. 346-368. Slotema, CW, Blom, JD, Hoek, HW & Sommer, IE 2010, 'Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders',J Clin Psychiatry, vol. 71, no. 7,Jul, pp. 873-884.