title: Clinical usefulness and economic implications of continuation/maintenance electroconvulsive therapy in a Spanish National Health System public hospital: A case series.
abstract: BACKGROUND
  Continuation/maintenance electroconvulsive therapy has been shown to be effective for prevention of relapse in affective and psychotic disorders. However, there is a limited nubber of studies that investigate clinical management, associated costs, and perceived quality variables.
  
  
  METHODS
  A series of 8 cases included during the first 18 months of the Continuation/Maintenance Electroconvulsive Therapy Program of the Psychiatry Department at 12 de Octubre University Hospital is presented. Clinical variables (Clinical Global Impression-Improvement Scale, length of hospitalization, number of Emergency Department visits, number of urgent admissions) before and after inclusion in the continuation/maintenance electroconvulsive therapy program were compared for each patient, as well as associated costs and perceived quality.
  
  
  RESULTS
  After inclusion in the program, 50.0% of 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 program, 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 hospitalization (P = .012), 26 Emergency Department visits (P = .011) and 22 urgent admissions (P = .010) during the same period before inclusion in the program. 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 patients assessed the care and treatment received as being « very satisfactory », and 12.5% as « satisfactory ».
  
  
  CONCLUSIONS
  This continuation/maintenance electroconvulsive therapy program has shown to be clinically useful and to have a favourable economic impact, as well as high perceived quality.
authors.affiliation: Servicio de Psiquiatría, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, España. Electronic address: roberto.rodriguez.jimenez@gmail.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rodriguez-Jimenez
authors.affiliation: Servicio de Psiquiatría, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, España.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bagney
authors.affiliation: Servicio de Psiquiatría, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, España.
authors.forename: Iosune
authors.initials: I
authors.lastname: Torio
authors.affiliation: Servicio de Psiquiatría, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, España.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Caballero
authors.affiliation: Unidad de Calidad, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Pedro
authors.initials: P
authors.lastname: Ruiz
authors.affiliation: Subdirección Médica, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Francisco de Paula Jose
authors.initials: Fde P
authors.lastname: Rivas
authors.affiliation: Servicio de Psiquiatría, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, España.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Jimenez-Arriero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000191:economics*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000191:economics / Q000628:therapy*; D012563:Schizophrenia, Paranoid / Q000191:economics / Q000628:therapy*; D013030:Spain; D016896:Treatment Outcome
keywords: Calidad; Continuación; Continuation; Cost-efectiveness; Coste-efectividad; Electroconvulsive therapy; Maintenance; Mantenimiento; Quality; Terapia electroconvulsiva