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BMC Psychiatry
Published in: BMC Psychiatry 1/2021

Open Access 01-12-2021 | Mood Disorders | Research

Cost-utility analysis of esketamine and electroconvulsive therapy in adults with treatment-resistant depression

Authors: Kinza Degerlund Maldi, Peter Asellus, Anna Myléus, Fredrik Norström

Published in: BMC Psychiatry | Issue 1/2021

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
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Metadata
Title
Cost-utility analysis of esketamine and electroconvulsive therapy in adults with treatment-resistant depression
Authors
Kinza Degerlund Maldi
Peter Asellus
Anna Myléus
Fredrik Norström
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-021-03601-8

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