Association between pulse width and health-related quality of life after electroconvulsive therapy in patients with unipolar or bipolar depression: an observational register-based study

To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression. This was an observational register study using data from the Swedish National Quality Registry for ECT (2011–2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before and after ECT. Multiple linear regressions were performed to investigate the association between pulse width (0.5 ms) and HRQoL (EQ-5D-3L index; EQ VAS) one week after ECT (primary outcome) and six months after ECT (secondary outcome). The sample included 5,046 patients with unipolar (82%) or bipolar (18%) depression. At first ECT session, 741 patients (14.7%) had pulse width 0.5 ms. There were no statistically significant associations between pulse width and HRQoL one week after ECT. In the subsample of patients with an EQ-5D index recorded six months after ECT (n = 730), patients receiving 0.5 ms had significantly lower HRQoL (−0.089) compared to p = .011). The corresponding analysis for EQ VAS did not show any statistically significant associations. No robust associations were observed between pulse width and HRQoL after ECT. On average, significant improvements in HRQoL were observed one week and six months after ECT for patients with unipolar or bipolar disease, independent of the pulse width received.</p

Additional file 1: of Effectiveness, costs and cost-effectiveness of chiropractic care and physiotherapy compared with information and advice in the treatment of non-specific chronic low back pain: study protocol for a randomised controlled trial

SPIRIT Checklist: recommended items to address in a clinical trial protocol. (PDF 130 kb

Travel characteristics of 1510 women attending the clinic-based cervical cancer screening program in Sweden.

<p>n = number.</p><p>^aIncludes bus, train and subway.</p><p>Travel characteristics of 1510 women attending the clinic-based cervical cancer screening program in Sweden.</p

Unit cost of resources expressed in 2009 Euros (€).

<p>^a) Indirect productivity-related costs are estimated based on travel time to and from care site, wait time and visit time [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref020" target="_blank">20</a>], treatment, and follow-up or sick leave due to cervical cancer [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref021" target="_blank">21</a>].</p><p>^b) KPP [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref032" target="_blank">32</a>].</p><p>^c) KPP 2009.</p><p>^d) Total cost including staging, treatment, and follow up [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref021" target="_blank">21</a>].</p><p>^e) Costs included procedure and pharmacological treatment at home and hospice care retrieved from the palliative care unit and advanced home care unit, Långbro Park, Stockholm County Council. Average cost per day of care at home was based on calculations from a previous Swedish report on advanced care at home in Sweden [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0139062#pone.0139062.ref025" target="_blank">25</a>].</p><p>^f) KPP 2009, clinical expert panel.</p><p>^g) The Dental and Pharmaceutical Benefits Agency (available in English at <a href="http://www.tlv.se" target="_blank">http://www.tlv.se</a>)</p><p>CIN: cervical intraepithelial neoplasia; LEEP: loop electrode excision procedure; KPP: cost per patient</p><p>Unit cost of resources expressed in 2009 Euros (€).</p

Cost of treating genital warts in Sweden, expressed in 2009 Euros (€).

<p>Cost of treating genital warts in Sweden, expressed in 2009 Euros (€).</p

Cost of Preventing, Managing, and Treating Human Papillomavirus (HPV)-Related Diseases in Sweden before the Introduction of Quadrivalent HPV Vaccination

<div><p>Objective</p><p>Costs associated with HPV-related diseases such as cervical dysplasia, cervical cancer, and genital warts have not been evaluated in Sweden. These costs must be estimated in order to determine the potential savings if these diseases were eradicated and to assess the combined cost-effectiveness of HPV vaccination and cervical cancer screening. The present study aimed to estimate prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts from a societal perspective in Sweden in 2009, 1 year before the quadrivalent HPV vaccination program was implemented.</p><p>Methods and Materials</p><p>Data from the Swedish cervical cancer screening program was used to calculate the costs associated with prevention (cytological cervical cancer screening), management (colposcopy and biopsy following inadequate/abnormal cytological results), and treatment of CIN. Swedish official statistics were used to estimate treatment costs associated with cervical cancer. Published epidemiological data were used to estimate the number of incident, recurrent, and persistent cases of genital warts; a clinical expert panel assessed management and treatment procedures. Estimated visits, procedures, and use of medications were used to calculate the annual cost associated with genital warts.</p><p>Results</p><p>From a societal perspective, total estimated costs associated with cervical cancer and genital warts in 2009 were €106.6 million, of which €81.4 million (76%) were direct medical costs. Costs associated with prevention, management, and treatment of CIN were €74 million; screening and management costs for women with normal and inadequate cytology alone accounted for 76% of this sum. The treatment costs associated with incident and prevalent cervical cancer and palliative care were €23 million. Estimated costs for incident, recurrent and persistent cases of genital warts were €9.8 million.</p><p>Conclusion</p><p>Prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts are substantial. Defining these costs is important for future cost-effectiveness analyses of the quadrivalent HPV vaccination program in Sweden.</p></div

Sociodemographic characteristics of 1510 women attending the clinic-based cervical cancer screening program in Sweden.

<p>n = number.</p><p>Sociodemographic characteristics of 1510 women attending the clinic-based cervical cancer screening program in Sweden.</p

Human papillomavirus (HPV) knowledge among 1510 women attending the clinic-based cervical cancer screening program in Sweden.

<p>y = years.</p><p>n = number.</p><p>All differences between groups are significant at <i>p<</i> .05 except following:</p><p>^a<i>p</i>-value .13 between women ≤29 y and women 30–49 y.</p><p>^b<i>p</i>-value .94 between women ≤29 y and women 30–49 y.</p><p>^c<i>p</i>-value .43 between women ≤29 y and women 30–49 y, .12 between women ≤29 y and women 50–60 y, .22 between women 30–49 y and women 50–60 y.</p><p>^d<i>p</i>-value .19 between women ≤29 y and women 30–49 y.</p><p>^e<i>p</i>-value .52 between women ≤29 y and women 30–49 y, .61 between women ≤29 y and women 30–49 y,. 97 between women 30–49 y and women 50–60 y.</p><p>^f<i>p</i>-value .9 between women ≤29 y and women 30–49 y, .46 between women ≤29 y and women 50–60 y, .37 between women 30–49 y and women 50–60 y.</p><p>^g<i>p</i>-value .41 between women ≤29 y and women 30–49 y, .052 between women ≤29 y and women 50–60 y, .12 between women 30–49 y and women 50–60 y.</p><p>^h<i>p</i>-value .36 between women ≤29 y and women 30–49, .061 between women ≤29 y and women 50–60 y.</p><p>Human papillomavirus (HPV) knowledge among 1510 women attending the clinic-based cervical cancer screening program in Sweden.</p

Correlates of human papillomavirus (HPV) knowledge and screening compliance for 1510 women attending the clinic-based cervical cancer screening program in Sweden.

<p>OR = odds ratio. CI = confidence interval.</p><p>^aTwo separate models were generated for the cohort after manual backward stepwise selection excluding non-significant variables. Therefore, not all variables were applicable in both models.</p><p>*Correlates of knowledge were determined using a dichotomous dependent variable based on the median (i.e.,≥ 5 or <5) HPV knowledge score. Therefore, “knowledge of HPV” is referred to ≥5 on the HPV knowledge score and “No knowledge of HPV” referred to <5 on the HPV knowledge score.</p><p>Correlates of human papillomavirus (HPV) knowledge and screening compliance for 1510 women attending the clinic-based cervical cancer screening program in Sweden.</p

Time and travel costs, direct non-medical costs and other related variables for 1510 women attending the clinic-based cervical cancer screening program in Sweden.

<p>n = number.</p><p>^aBased on data on average time for medical procedure and wait time from a total of 348 attendances in two outpatient clinics at four occasions respectively.</p><p>^bIncludes bus, train and subway.</p><p>^cA total of 1980 hours off work were estimated based on 807 women (1980/807 = 147 minutes).</p><p>^dA total of 203 hours off work were estimated based on 108 individuals accompanying the women(203/108 = 113 minutes).</p><p>^eA total of 98 hours were estimated as child care for 35 women (98/35 = 168 minutes).</p><p>^fA cost of €28 per hour were calculated on an estimated total cost of €2740 paid for 98 hours child care (28x2.8 = €78.4).</p><p>^gA total of 20 hours were estimated as unpaid child care for 7 women (20/7 = 171 minutes).</p><p>^hA total cost of €247.6 for unpaid child care were estimated based on €12.38 per hour (i.e., cost for leisure time). Mean cost were then calculated on 7 women attending screening (247.6/7 = €35.4).</p><p>ⁱA total of 85 women paid parking fees estimated to a total of €238.5 (238.5/85 = €2.8).</p><p>Time and travel costs, direct non-medical costs and other related variables for 1510 women attending the clinic-based cervical cancer screening program in Sweden.</p