Factors Associated With Global Variability in Electroconvulsive Therapy Utilization

Rakita, Uros; Bingham, Kathleen; Fung, Kenneth; Giacobbe, Peter

doi:10.1097/yct.0000000000000405

Cited by 12 publications

(7 citation statements)

References 45 publications

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“…If the TPR for ECT in other (geographical) European countries are taken as comparative values, it becomes apparent that Switzerland is in the lower midfield in terms of ECT patients (Table 2). As this selective sample on TPR makes clear, strong variations in patient treatment rates are evident 33 . These differences also extend at the global level, not only in terms of patient utilization rates, but also in terms of ECT application, administration, and practice.…”

Section: Discussionmentioning

confidence: 84%

“…As this selective sample on TPR makes clear, strong variations in patient treatment rates are evident. 33 These differences also extend at the global level, not only in terms of patient utilization rates, but also in terms of ECT application, administration, and practice. Switzerland and countries with comparable TPRs also rank in the lower middle range in a global comparison-the average TPR worldwide is estimated to be 23.4 persons treated per 100,000 population.…”

Section: Application Of Ect In International Comparisonmentioning

confidence: 99%

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Electroconvulsive Therapy in Switzerland

Wilhelmy

Brühl

Himmighoffen

et al. 2023

J ECT

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Objectives:The prevalence and use of electroconvulsive therapy (ECT) varies widely across Europe. Historically, Switzerland played an important role in the worldwide spread of ECT. Nevertheless, an overview of current ECT practice in Switzerland is still lacking. The present study aims to fill this gap.Methods: A cross-sectional study was conducted in 2017 using a standardized questionnaire to investigate current ECT practice in Switzerland. Fifty-one Swiss hospitals were contacted by email and followed up by telephone. In early 2022, we updated the list of facilities that offer ECT.Results: Thirty eight of the 51 hospitals (74.5%) provided feedback to the questionnaire, 10 of them claimed to offer ECT. They reported 402 treated patients, which corresponds to an ECT-treated person rate of 4.8 persons per 100,000 inhabitants. Depression was the most frequent indication. All hospitals reported an increase in ECT treatments between 2014 and 2017 except for one with constant numbers. The number of facilities offering ECT almost doubled between 2010 and 2022. Most ECT facilities performed the treatment predominantly on an outpatient rather than an inpatient basis.Conclusions: Historically, Switzerland relevantly contributed to the worldwide spread of ECT. In an international comparison, the treatment frequency is in the lower middle range. The outpatient treatment rate is high compared with other countries in Europe. The supply and spread of ECT in Switzerland have increased over the past decade.

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Section: Discussionmentioning

confidence: 84%

Section: Application Of Ect In International Comparisonmentioning

confidence: 99%

Electroconvulsive Therapy in Switzerland

Wilhelmy

Brühl

Himmighoffen

et al. 2023

J ECT

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“…In a study comparing published rates of ECT and antidepressant medication utilization across nations, and the impact of health, social, and economic indices, Rakita et al found that government expenditure on mental health was the only significant contributor to global variation in ECT use worldwide, while the Human Development Index, a composite index of life expectancy, education rates, and per capita income indicators, significantly correlates with global antidepressant utilization. 27 These findings suggest that across the globe, ECT, and as an extension, other Interventional Psychiatric approaches that also require equipment and multiple personnel for delivery, can be a bellwether measure of the degree to which a nation financially invests in mental health care for its citizens. Although there are no population data available on rTMS utilization across Canada, the ability to access this Health Canada approved treatment varies by province as a function of whether it is publicly funded.…”

Section: Funding/advocacymentioning

confidence: 99%

Interventional Psychiatry and Neurotechnologies: Education and Ethics Training

Giacobbe

Burhan

Waxman

et al. 2023

Can. J. Neurol. Sci.

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ABSTRACT:The last two decades have seen dramatic growth in the application of procedurally based interventions for treating refractory psychiatric conditions, leading to interest in developing the foundations for the subspecialty of “Interventional Psychiatry.” However, there is cause for concern that the rate of expansion of clinical advances in this field may be outpacing the ability of postgraduate curricula to provide sufficient exposure to and teaching and supervision of these treatments. The paucity of adequately trained practitioners in Interventional Psychiatry further exacerbates inequities in the ability of eligible patients to access and benefit from these approaches. This paper explores the rates of utilization of Interventional Psychiatry treatments, the current state of education in these treatments, and the role that training can play in translating scientific advances in this area to ensure equitable access and maximum impact at a population level. The majority of the discussion is centered on electroconvulsive therapy (ECT), the most established and available of these treatments, highlighting how enhancing education and training in ECT can reduce barriers to its utilization. It is argued that innovations in pedagogical approaches for disseminating the learning of these procedures are needed to increase the current low rates of competency in these treatments and can facilitate the more rapid dissemination of other Interventional Psychiatry approaches and neurotechnologies, such as repetitive transcranial magnetic stimulation, ketamine, deep brain stimulation, and focused ultrasound.

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“…Moreover, in a recent large observational study of older patients, ECT was associated with a lower one-year all-cause mortality and reduced suicide rates during three months after treatment [ 8 ]. Despite the consistent evidence that ECT is an effective treatment for patients with TRD, research suggest that it is underutilised [ 9 – 11 ]. This is partly due to limited availability of ECT, patient choice, stigma and a dated perception of the treatment [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the consistent evidence that ECT is an effective treatment for patients with TRD, research suggest that it is underutilised [ 9 – 11 ]. This is partly due to limited availability of ECT, patient choice, stigma and a dated perception of the treatment [ 9 – 11 ]. It is also due to the fact that maintenance ECT (M-ECT) might be required, a practice that is uncommon in England [ 12 ] and not supported by UK National Institute for Health and Care Excellence (NICE) as routine treatment [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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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Factors Associated With Global Variability in Electroconvulsive Therapy Utilization

Abstract: These findings suggest that across the globe ECT but not antidepressant medication utilization is associated with the degree to which a nation financially invests in mental health care for its citizens.

Cited by 12 publications

References 45 publications

Electroconvulsive Therapy in Switzerland

Electroconvulsive Therapy in Switzerland

Interventional Psychiatry and Neurotechnologies: Education and Ethics Training

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

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