Electroconvulsive therapy (ECT) may be effective and
cost-effective for patients with treatment-resistant depression, according to research
published online 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, randomised trials, and observational
studies.

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 percent of life-years over four years; greater improvements were seen
when ECT was offered earlier. There was an increase in mean healthcare costs by
$7300 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.

Source: http://www.physiciansbriefing.com/Article.asp?AID=733786

Reference: Ross
EL, et al. Cost-effectiveness of Electroconvulsive Therapy vs
Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United
States. Jama Psychiatry. Published online 9 May 2018. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2680312