ECT Effective for Treatment-Resistant Depression

Electroconvulsive therapy (ECT) may be beneficial and cost-effective for patients with treatment-resistant depression, according to a recent study.

Treatment-resistant depression (TRD) is a leading cause of premature mortality due to suicide and associated medical conditions and high social impairments, with large direct and indirect healthcare costs. Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses.

Eric L. Ross and his 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.

The researchers projected that over 4 years, ECT would reduce the amount of time that a patient experienced uncontrolled depression from roughly half of the patient's life-years to roughly one-third of the patient's life-years. The model predicted that greater improvements would be experienced if ECT were introduced 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.

Eric L. Ross, the lead author said that the main finding for clinicians is that ECT is a cost-effective treatment option for people with TRD, even though ECT is very expensive, its benefits are great enough to make it a good value.

The study found that offering ECT relatively early in the course of the depression treatment after a patient has failed to respond to two prior treatments, is cost-effective. In a range of univariate, scenario, and probabilistic sensitivity analyses, third-line ECT remained cost-effective.

The study concluded that from a health-economic point of view, ECT should be considered after failure of two or more lines of pharmacotherapy/psychotherapy.

The study was published in the journal JAMA Psychiatry