From the Journals

ECT cost effective in treatment-resistant depression

 

Key clinical point: Electroconvulsive therapy (ECT) should be considered as a third-line treatment after two or more lines of pharmacotherapy and/or psychotherapy have failed.

Major finding: Third-line ECT had an incremental cost-effectiveness ratio of $54,000/quality-adjusted life-year.

Study details: A simulation of depression treatment using a decision analytic model taking into account the efficacy, cost, and quality of life impact of ECT based on meta-analyses, randomized trials, and observational studies.

Disclosures: The study was supported by the Department of Veterans Affairs Health Services Research & Development Services. Authors had no conflicts of interest to report.

Source: Ross EL et al. JAMA Psychiatry. 2018 May 9. doi: 10.1001/jamapsychiatry.2018.0768.


 

FROM JAMA Psychiatry

Electroconvulsive therapy might be a cost-effective treatment option for patients with treatment-resistant depression, results of a mathematical modeling analysis suggest.

The health-economic value of electroconvulsive therapy is most likely maximized when the intervention is tried after two failed lines of pharmacotherapy/psychotherapy, authors of the analysis said in JAMA Psychiatry.

“Increasing use of ECT by offering it earlier in the course of treatment-resistant depression could greatly improve outcomes for this difficult-to-treat patient population,” wrote Eric L. Ross, a medical student at the University of Michigan, Ann Arbor.

In clinical practice, patients with uncontrolled depression might not be offered electroconvulsive therapy for months or years, despite evidence from multiple studies that it is significantly more effective than pharmacotherapy in that setting, Mr. Ross and his coauthors in the university’s department of psychiatry wrote in their report.

One barrier to use of electroconvulsive therapy might be its cost, which they said can run in excess of $10,000 for initial therapy and maintenance treatments, compared with several hundred dollars for an antidepressant prescription.

However, data are limited showing the efficacy of electroconvulsive therapy in relation to that higher price tag. Accordingly, the investigators used a decision analytic model to simulate the clinical and economic effects of seven different electroconvulsive therapy treatment strategies, and calculated the incremental cost-effectiveness ratio of each.

Over a 4-year horizon, treatment with electroconvulsive therapy would reduce time with uncontrolled depression from 50%, down to 32.9%-37.1%, depending on the treatment strategy, the investigators found.

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