ECT Effective for Treatment-Resistant Depression

Third-line electroconvulsive therapy also cost-effective in base case, and in a range of sensitivity analyses.
Third-line electroconvulsive therapy also cost-effective in base case, and in a range of sensitivity analyses.

HealthDay News — Electroconvulsive therapy (ECT) may be effective and cost-effective for US patients with treatment-resistant depression, according to research published online May 10 in JAMA Psychiatry.

Eric L. Ross, from the University of Michigan Medical School in Ann Arbor, and colleagues examined the cost-effectiveness of ECT versus pharmacotherapy/psychotherapy for treatment-resistant major depression. Data were included from multiple meta-analyses, randomized trials, and observational studies. 

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The researchers simulated a population with a mean age of 40.7 years based on the Sequenced Treatment Alternatives to Relieve Depression trial. ECT was projected to reduce time with uncontrolled depression from 50 to 33 to 37% of life-years over 4 years; greater improvements were seen when ECT was offered earlier. There was an increase in mean health care costs by $7,300 to $12,000; the incremental costs were greater when ECT was offered earlier. Third-line ECT was cost-effective in the base case, with an incremental cost-effectiveness ratio of $54,000 per quality-adjusted life-year. In a range of univariate, scenario, and probabilistic sensitivity analyses, third-line ECT remained cost effective. The likelihood that at least one ECT strategy is cost-effective was estimated at 74 to 78% incorporating all input data uncertainty; there was a 56 to 58% likelihood that third-line ECT was the optimal strategy.

"These data suggest that, from a health-economic standpoint, ECT should be considered after failure of two or more lines of pharmacotherapy/psychotherapy," the authors write.

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