The Use of Electroconvulsive Therapy in France: Initial National Findings Underline Significant Disparities

Lecarpentier P. (EPS Barthélémy Durand, IRDES), Gandré C. (IRDES), Coldefy M. (IRDES) in collaboration with Ellini A. (ATIH)

Questions d'économie de la santé (Issues in Health Economics) n° 267 - April 2022

QES n° 267

Electroconvulsive therapy (ECT) consists of triggering an epileptic crisis under general anaesthesia. It is one of the recommended treatments for severe psychiatric disorders that are resistant to standard treatments, particularly pharmacological ones. This procedure is associated with negative representations in the public mind, its mechanisms of action remain little understood and the literature on the wide-scale use of ECT is scarce. In this context, this study examined the use of ECT in mainland France in 2019 and identified the main factors associated with its variation, using hospital activity data from the French Agency for Information on Hospital Care (Agence technique de l'information sur l'hospitalisation, ATIH), which, since 2017, includes an exhaustive record of ECT procedures. According to this data, ECT was used to treat 3,705 persons (44,668 procedures) in France in 2019; it is therefore a highly specialised treatment that is rarely prescribed. Just over 1% of adults hospitalised for at least one whole day in psychiatric facilities were treated with ECT, and they were older, most often female, and had more severe and complex psychiatric disorders than the other persons hospitalised under the same conditions. These clinical characteristics comply with national clinical guidelines. Nevertheless, significant variations in the rate of use of ECT have been observed between hospitals in charge of referrals to this procedure. Furthermore, these variations did not seem to be solely associated with patients’ characteristics but also -and much more significantly- with health care supply characteristics: in particular, the type of facility in charge of the psychiatric follow-up and the distance to the closest facility providing ECT. This finding raises questions about the heterogeneity of treatments for psychiatric disorders and the access to specialised psychiatric care.

See also Questions d'économie de la santé n° 267 in French: Le recours à l'électroconvulsivothérapie en France : des premières données nationales qui soulignent des disparités importantes.