title: Introduction of vagus nerve stimulation into a maintenance electroconvulsive therapy regimen: a case study and cost analysis.
abstract: OBJECTIVE
  This case report describes the outcome of a patient implanted with the vagus nerve stimulation (VNS) device while receiving maintenance electroconvulsive treatment (M-ECT) and compares the costs of treatment options for treatment-resistant depression.
  
  
  METHODS
  The patient, a male, aged 47 years with bipolar I disorder, treatment-resistant depression, and a 13-year history of depressions, was receiving M-ECT at 2-week intervals as well as antidepressant medications when he was implanted with the VNS device. His depression was assessed with the Montgomery-Asberg Depression Rating Scale. The cost analysis of treatment modalities placed M-ECT at $800 to $1000 per treatment and VNS at approximately $3900 annually (surgery, device, and office visits, approximately $31,300, was prorated over 8 years).
  
  
  RESULTS
  Antidepressants and other medications were used in combination and were gradually changed while the patient was receiving electroconvulsive therapy. The patient improved with VNS and was able to discontinue M-ECT. His Montgomery-Asberg Depression Rating Scale scores had fluctuated between 2 and 56, but, after VNS, the scores decreased to a level consistent with remission and have remained at those levels. The patient reported feeling as well as he had felt at any time he could remember, began an exercise program, and lost 30 lbs. During the 10 months before implantation, 14 electroconvulsive therapy treatments cost $11,200 to $14,000. For 10 months after implantation, 7 M-ECT treatments ($5600-$7000) plus prorated VNS ($3250) equaled $8850 to $10,250, $2350 to $3750 less than before implantation.
  
  
  CONCLUSIONS
  This patient improved with VNS and was able to discontinue M-ECT. Introducing VNS effected a cost savings over M-ECT.
authors.affiliation: Department of Psychiatry, Loma Linda University, Loma Linda, CA 92354, USA. rwarnell@ahs.llumc.edu
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Warnell
authors.forename: Nazanin
authors.initials: N
authors.lastname: Elahi
mesh_terms: D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000628:therapy*; D003131:Combined Modality Therapy; D003365:Costs and Cost Analysis; D003863:Depression / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000191:economics; D004565:Electroconvulsive Therapy / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D014630:Vagus Nerve
chemical_list: D000928:Antidepressive Agents