Clinical Outcomes of Continuation and Maintenance Electroconvulsive Therapy

Area of Science:

• Psychiatry
• Neurology
• Health Economics

Background:

• Large-scale evidence for the efficacy of continuation and maintenance electroconvulsive therapy (c/mECT) is lacking.
• Real-world outcomes and cost-effectiveness of c/mECT require further investigation.

Purpose of the Study:

• To provide an exhaustive and naturalistic insight into the real-world outcomes of c/mECT.
• To evaluate the cost-effectiveness of c/mECT in a large dataset.

Main Methods:

• A nationwide cohort study of patients initiating ECT from 2003-2022 using the Danish National Patient Registry.
• An algorithm identified c/mECTs, defined by treatment frequency and timing relative to acute ECT (aECT).
• Cox proportional hazard regression, propensity score matching, and self-controlled case series analysis were used to assess outcomes; cost-effectiveness was analyzed.

Main Results:

• Of 19,944 individuals treated with ECT, 7.7% received c/mECT.
• c/mECT was associated with a lower rate of hospitalization post-aECT (e.g., 6-month adjusted hazard ratio, 0.68) and a substantial reduction in total treatment costs.
• No significant difference was found in the risk of suicidal behavior.

Conclusions:

• Continuation and maintenance electroconvulsive therapy (c/mECT) is infrequently used but associated with reduced readmission rates compared to acute ECT (aECT) alone.
• The findings suggest c/mECT should be considered more often to prevent relapse in patients with treatment-resistant conditions.
• c/mECT demonstrated significant cost-effectiveness by reducing hospitalization expenses.