Cost-utility of 2 maintenance treatments for older adults with depression who responded to a course of electroconvulsive therapy: results from a decision analytic model.

OBJECTIVE The prevalence of major depressive disorder (MDD) in community-dwelling elderly populations is 1% to 3%. After initial treatment of the acute phase of depression, only about 25% to 30% of elderly patients remain well after 1 to 3 years of follow-up. Previous studies suggested that patients who received maintenance electroconvulsive therapy (MECT) demonstrated lower relapse rates, a better subjective sense of well-being, and lower health care costs at 12-month follow-up. This study provides a cost-utility analysis of 2 maintenance treatments for recurrent depression in elderly patients. METHOD We used a Markov decision model to compare maintenance pharmacotherapy (MPT) with MECT in a theoretical cohort of elderly individuals with MDD who responded to an initial course of ECT. We estimated total costs and total quality-adjusted life years (QALYs) for each strategy as well as the cost per QALY. RESULTS The model produced a cost per patient of dollar 436,102 for MPT and dollar 281,356 for MECT. The MPT strategy yielded 7.55 QALYs and the MECT strategy yielded 11.43 QALYs. Therefore, MPT cost dollar 57,762 per QALY and MECT cost dollar 24,616 per QALY. CONCLUSION Our model suggests that MECT may be more cost-effective than MPT in the maintenance treatment of older adults with depression who have responded to a course of acute ETC.