Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
BMC Psychiatry. 2021 Dec 7;21(1):610. doi: 10.1186/s12888-021-03601-8.
Electroconvulsive therapy (ECT) has long been used for treating individuals with treatment-resistant depression (TRD). Esketamine has recently emerged as a new treatment for TRD due to its rapid antidepressant effects. To further inform the decision regarding choice of treatment, this paper aims to evaluate whether ECT or esketamine is the more cost-effective option.
The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model from a societal and life-time perspective. The incremental cost-effectiveness ratio (ICER) was calculated. Health states included different depression and remission states and death. Data to populate the model was derived from randomised controlled trials and other research. Various sensitivity analyses were carried out to test the robustness of the model.
The base case scenario shows that ECT is cost-effective compared to esketamine and yields more QALYs at a lower cost. The sensitivity analysis shows that ECT is cost-effective in all scenarios and ECT dominates esketamine in 12 scenarios.
This study found that, from a cost-effectiveness point of view, ECT should be the first-hand option for individuals with TRD, when other first line treatments have failed. Considering the lack of economic evaluation of ECT and esketamine, this study is of great value to decision makers.
电抽搐疗法（ECT）长期以来一直被用于治疗治疗抵抗性抑郁症（TRD）患者。由于其快速的抗抑郁作用，艾司氯胺酮最近已成为治疗 TRD 的一种新选择。为了进一步为治疗选择提供信息，本文旨在评估 ECT 或艾司氯胺酮哪个更具成本效益。
从社会和终生角度采用 Markov 模型，推导出成本效益，即每质量调整生命年（QALY）的成本。计算增量成本效益比（ICER）。健康状态包括不同的抑郁和缓解状态以及死亡。用于填充模型的数据来自随机对照试验和其他研究。进行了各种敏感性分析以测试模型的稳健性。
基本情况表明，与艾司氯胺酮相比，ECT 更具成本效益，且成本更低，可获得更多的 QALYs。敏感性分析表明，ECT 在所有情况下均具有成本效益，并且在 12 种情况下 ECT 优于艾司氯胺酮。
本研究从成本效益角度发现，对于其他一线治疗失败的 TRD 患者，ECT 应作为首选。鉴于缺乏对 ECT 和艾司氯胺酮的经济评估，本研究对决策者具有重要价值。
