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  • Question on Consultation

    Do you agree on the proposal for withdrawing this technology appraisal? If not, please can you state why you disagree.

  • Question on Consultation

    Are you aware of any implications for UK clinical practice on withdrawing this technology appraisal? If so, please describe.

2025 surveillance of electroconvulsive therapy (technology appraisal guidanceTA59, NICE guideline NG222, NICE guideline CG178, NICE guideline CG185, NICE guideline CG192)

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Budget impact/Economic considerations

There is a health economic model in TA59 for schizophrenia based on a review of published evidence. They were not able to construct robust models for mania and catatonia because of the low volume of data in these areas. The results of the schizophrenia model suggest that ECT is dominated by clozapine – that is, ECT is associated with fewer QALYs (0.842 versus 0.863) at a higher cost (£55,267 versus £34,787). For individuals who do not respond to clozapine, ECT dominates chlorpromazine/haloperidol, resulting in more QALYs (0.842 versus 0.820) at a lower cost (£55,267 versus £58,265). However, these results do not take into account the degree of uncertainty in the estimates of both cost and effectiveness.

In NICE guideline NG222, 2 economic studies were reviewed. One study found that ECT combined with SSRIs (selective serotonin reuptake inhibitors) and lithium augmentation was the most cost-effective treatment for major depressive disorder. The other assessed ECT for treatment-resistant depression but lacked comparative data and evidence synthesis, limiting its relevance for decision-making.