The effect of Outpatient Continuation Electroconvulsive Therapy (C-ECT) on the Readmission Risk and Total Direct Cost in Patients with Depressive, Bipolar and Psychotic Disorders: A Naturalistic Retrospective Cohort Study
Bibliographic record
Abstract
Abstract Background: The effect of continuation/maintenance ECT (C-ECT) across mood and psychotic disorders on the readmission risk and cost is unclear. Objective: To assess the association of outpatient C-ECT on the readmission risk and the total direct healthcare cost after completion of inpatient acute ECT. Methods: A naturalistic retrospective cohort study of 540 patients who received inpatient acute ECT treatment from May 2017 to Mar 2021 in a large tertiary psychiatric institution was conducted. Brief Psychiatric Rating Scale (BPRS), Montgomery-Asberg Depression Rating Scale (MADRS), Montreal Cognitive Assessment (MoCA), Global Assessment of Functioning (GAF), EQ-5D-3L utility scale (EQ-5D), and the Clinical Global Impressions Scale-Improvement (CGIS-I) were used. After completion of inpatient acute ECT, patients receiving and not receiving outpatient C-ECT were compared using survival analysis for readmission risk. Hospitalisation and ECT treatment cost were used to calculate total direct cost. Results: After the first 6 sessions of inpatient acute ECT, both cohorts had significant improvement in their BRPS, MADRS, GAF and EQ-5D scores. Patients who continued with outpatient C-ECT after acute ECT had a significantly lower risk of readmission [adjusted hazard ratio of 0.68 (95% CI: 0.49 – 0.95, p=0.022)]. Amongst patients with bipolar disorders and schizophrenia-spectrum disorders, involuntary status at the index admission was associated with a lower risk of hospital readmission. Patients who received outpatient C-ECT had a significantly lower total direct cost compared to those who did not (SGD$35,259 vs SGD$61,337). Patients with mood disorders had a significantly lower inpatient ECT cost, hospitalisation cost and total direct costs in the outpatient C-ECT group compared to those without outpatient C-ECT. Conclusion: ECT is a quick and effective acute treatment for mood and psychotic disorders. Outpatient C-ECT for the treatment of mood and psychotic disorders is associated with lower readmission risks and lower healthcare costs, especially for patients with mood disorders Research Category and Technology and Methods Clinical Research: 2. Electroconvulsive Therapy (ECT) Keywords: ECT, Outpatient, Cost effectiveness, Capacity
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".