From prediction to action: developing a risk-stratified management tool for children with new-onset tic disorders.

Major depressive disorder (MDD), one of the most burdensome mental disorders globally, is estimated to affect over 95 million people in China. It not only severely impairs patients’ social functioning and quality of life but also continuously increases healthcare resource utilization and socioeconomic costs [, ]. Current first-line treatments typically involve selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. However, the remission rate remains below 50%, and issues such as delayed onset of action, high risk of relapse, and poor tolerability lead many patients to develop treatment-resistant depression [], further exacerbating long-term treatment needs and economic burdens. This reality has driven clinicians and researchers to explore more effective and tolerable adjunctive treatment strategies to improve symptom control and reduce relapse []. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are two non-invasive brain stimulation techniques that have gained considerable attention in the treatment of depression in recent years []. rTMS uses magnetic fields to induce electrical currents in the cerebral cortex, modulating neural network activity involved in emotion regulation [], while tDCS applies low-intensity direct current to alter cortical neuronal excitability, thereby promoting neuroplasticity and improving mood and cognitive function [–]. Numerous clinical trials have demonstrated that both techniques, when used alongside pharmacotherapy, can further improve response and remission rates with favorable safety profiles [–]. The Phase II randomized controlled trial by Zhou D et al. (2024) (Registration No. ChiCTR2100052122; October 19, 2021), which compared the efficacy of rTMS, tDCS, and their combination as adjunctive therapies to antidepressants [], reported a markedly higher response rate of 83.3% for rTMS+tDCS over a 4-week period in Chinese patients, compared to 71.7% for rTMS alone and 61.7% for tDCS alone—all significantly superior to the 55.0% response rate with pharmacotherapy alone, with a favorable safety profile. Although both rTMS and tDCS demonstrate notable clinical efficacy and safety, existing pharmacoeconomic literature has primarily focused on the cost-effectiveness of rTMS as an adjunctive treatment, generally affirming its favorable cost-utility profile [–]. In contrast, economic evidence for tDCS and its combination with rTMS remains scarce. Different treatment modalities may lead to varying health outcomes and cost structures, and the absence of comprehensive analysis based on Chinese healthcare costs, social expenditures, and health utility values limits informed decision-making regarding the integration of these technologies into clinical pathways and health insurance policies.