Original Research
Cost–Utility of 2 Maintenance Treatments for Older
Adults With Depression Who Responded to a Course of
Electroconvulsive Therapy: Results From a Decision
Analytic Model
Mohamed Aziz, MD, MS1, Ann M Mehringer, MS2, Ellen Mozurkewich, MD2,
Gihan N Razik, MD3
Key Words: depression in elderly, maintenance electroconvulsive therapy, decision analytic models
The prevalence of MDD in community-dwelling elderly
populations is 1% to 3%, and an additional 8% to 16% of
elderly persons have clinically significant depressive symp-
toms or subsyndromal symptoms (1,2). The prevalence of
MDD among elderly hospitalized patients is 5% to 13%; in
nursing home residents, it is 12% to 16%; and in residents of
long-term care facilities, it is about 50% (3). In 1991, Kupfer
reported that 50% of patients treated for a first episode of
MDD will have a second episode. Following a second epi-
sode, the risk of a third episode is likely in 80% to 90% of
patients (4).
Depressive symptoms are associated with increased risk of
disability and impaired psychosocial functioning (5). Elderly
patients with depressive symptoms have higher mortality
Can J Psychiatry, Vol 50, No 7, June 2005
389
Objective: The prevalence of major depressive disorder (MDD) in community-dwelling elderly
populations is 1% to 3%. After initial treatment of the acute phase of depression, only about 25% to
30% of elderly patients remain well after 1 to 3 years of follow-up. Previous studies suggested that
patients who received maintenance electroconvulsive therapy (MECT) demonstrated lower relapse
rates, a better subjective sense of well-being, and lower health care costs at 12-month follow-up.
This study provides a cost–utility analysis of 2 maintenance treatments for recurrent depression in
elderly patients.
Method: We used a Markov decision model to compare maintenance pharmacotherapy (MPT) with
MECT in a theoretical cohort of elderly individuals with MDD who responded to an initial course of
ECT. We estimated total costs and total quality-adjusted li