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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.

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    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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Methods

The exceptional surveillance process consisted of:

  • Literature searches to identify relevant evidence.

  • Considering the new evidence and intelligence that triggered the exceptional review.

  • Considering the economic aspects of the changes in the clinical evidence base.

  • Considering the evidence used to develop the guidance/guideline in the update.

  • Examining related NICE guidance and quality standards.

  • Examining the NICE event tracker for relevant ongoing and published events.

  • Assessing the new evidence and information against current recommendations to determine whether or not to update sections of the guidance/guideline or the whole guidance/guideline.

For further details about the process and the possible update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.

Search and selection strategy

We carried out a literature search to evaluate evidence on the effectiveness and safety of ECT published since the evidence was reviewed to inform NICE guidance.

For NICE guidance TA59, the focus was on schizophrenia, mania, and catatonia in adults, comparing ECT with pharmacological and therapy-based treatments while assessing adverse events, safety, cost-effectiveness, and symptom reduction. The search, limited to systematic reviews and randomised controlled trials (RCTs) published since 2010, identified 692 relevant references. This focus ensured that the evidence considered is of the highest quality, providing reliable and robust findings to inform update proposal.

For NG222, the focus was on ECT for treating depression, including severe, recurring, moderate, and nonpsychotic cases. It assessed effectiveness, safety, relapse prevention, and cost-effectiveness compared to pharmacological and therapy-based treatments. Systematic reviews and RCTs published since 2019 were included, alongside large observational safety studies where available. We identified 446 relevant references.

Searches were carried out across Medline, Embase, Cochrane (CENTRAL), and PsycINFO. The enquirers also provided 14 references, of which 4 were identified through our searches and included in this surveillance review, while the remaining did not meet our inclusion criteria.