Clinical usefulness and economic implications of continuation/maintenance electroconvulsive therapy in a Spanish National Health System public hospital: A case series

Introduction Continuation/maintenance electroconvulsive therapy has been shown to be effective for prevention of relapse in affective and psychotic disorders. However, there are a limited number of studies that investigate clinical management, associated costs, and perceived quality variables. Material and methods A series of 8 cases included during the first 18 months of the continuation/maintenance electroconvulsive therapy programme of the Psychiatry Department at 12 de Octubre University Hospital is presented. Clinical variables (clinical global impression-improvement scale, length of hospitalisation, number of emergency department visits, number of urgent admissions) before and after inclusion in the continuation/maintenance electroconvulsive therapy programme were compared for each patient, as well as associated costs and perceived quality. Results After inclusion in the programme, 50.0% of the patients reported feeling “much better” and 37.5% “moderately better” in the clinical global impression-improvement scale. In addition, after inclusion in the continuation/maintenance electroconvulsive therapy programme, patients were hospitalized for a total of 349 days, visited the Emergency Department on 3 occasions, and had 2 urgent admissions, compared to 690 days of hospitalisation ( p = 0.012), 26 Emergency Department visits ( p = 0.011) and 22 urgent admissions ( p = 0.010) during the same period before inclusion in the programme. Associated direct costs per day of admission were reduced to 50.6% of the previous costs, and costs associated with emergency department visits were reduced to 11.5% of the previous costs. As regards perceived quality, 87.5% of the patients assessed the care and treatment received as being “very satisfactory”, and 12.5% as “satisfactory”. Conclusions This continuation/maintenance electroconvulsive therapy programme has shown to be clinically useful and to have a favourable economic impact, as well as high perceived quality.