Skip to main content
Search
Search
Advanced Search
Skip main navigation
Open access
Research Article
22 May 2025

Impact analysis of expanded access to ketamine for treatment-resistant depression

Authors: Thanh Lu https://orcid.org/0000-0002-5707-0339 [email protected], Sophia D'Angelo https://orcid.org/0000-0003-4564-1058, Zohra Tayebali https://orcid.org/0000-0001-6760-9038, Matthew Dempsey https://orcid.org/0000-0002-0758-2029, Kristen Giombi https://orcid.org/0000-0002-8788-0391, and Olga Khavjou https://orcid.org/0000-0003-0805-0769Author Info & Affiliations
Volume 14, Number 6
https://doi.org/10.57264/cer-2024-0233
PDFFormats

Abstract

Aim: This study aimed to estimate the economic impacts of expanded access to ketamine relative to electroconvulsive therapy (ECT) by offering intravenous ketamine to US patients with nonpsychotic treatment-resistant depression (TRD) and moderate-to-severe depression. Materials & methods: A population-level Markov simulation model with key parameters from a randomized trial was used to simulate the economic impacts of managing TRD with intravenous ketamine versus ECT over a 5-year horizon. Health states included response of depression in the acute treatment phase and continued treatment and relapse in the maintenance phase. The model estimated costs associated with healthcare utilization (direct costs) and time loss (indirect costs) from patient, caregiver, payer and societal perspectives. Model uncertainty was assessed with one-way sensitivity, probabilistic sensitivity and scenario analyses. Results: In year 1, our model included 350,000 eligible patients. In years 2 through 5, our model added 11,296 eligible patients annually. Expanded access to ketamine to manage TRD was projected to increase the number of patients receiving treatment by 75,000 patients in year 1 and 4292 patients annually in subsequent years. Over 5 years, expanded access to ketamine would result in a net positive societal savings of $828.2 million annually ($95.3 million to patients and $743.7 million to payers). However, expanded ketamine access would impose an additional $10.8 million burden on caregiver time annually. Conclusion: For US patients with TRD and moderate-to-severe depression, ketamine may be a noninferior treatment relative to ECT to improve depression symptoms. Expanded access to ketamine treatment would result in net savings to the patients, payers and society.

Plain language summary

What was the aim of this research?

To estimate the economic impacts of expanded access to intravenous ketamine relative to electroconvulsive therapy by offering ketamine to US patients with treatment-resistant depression and moderate-to-severe depression without psychotic features from the patient, caregiver, payer and societal perspectives.

How was the research carried out?

A population level Markov simulation model and annual Markov cycles was performed out to 5 years. Model parameters were identified from the literature, publicly available data sources and input from a clinical consultant. Sensitivity analyses were used to explore variations in some inputs and assumptions.

What were the results?

Results suggest that expanded access to intravenous ketamine has the potential to increase the number of patients in treatment for treatment-resistant depression and lead to annual savings to society of US$828.2 million in total or US$19,940 per patient-in-treatment. Patients and payers incurred a total saving of $95.3 million and $743.7 million, respectively, annually. However, caregivers incurred an additional cost of $10.8 million annually.

What do the results of the study mean?

Expanded access to ketamine would result in net annual savings to society, patients and payers but would impose burdens on caregivers annually due to the additional time spent transporting patients to and from treatment.

Supplementary Material

File (supplementary figure a1.docx)
File (supplementary table a1.docx)
File (supplementary table a2.docx)

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
National Institute of Mental Health (NIMH). Depression. Accessed: 10 July 2024: https://www.nimh.nih.gov/health/topics/depression
Google Scholar
2.
Zhdanava M, Pilon D, Ghelerter I et al. The prevalence and national burden of treatment-resistant depression and major depressive disorder in the United States. J. Clin. Psychiatry 82(2), 20m13699 (2021).
PubMed
Google Scholar
3.
Sussman M, O'Sullivan AK, Shah A, Olfson M, Menzin J. Economic burden of treatment-resistant depression on the U.S. health care system. J. Manag. Care Spec. Pharm. 25(7), 823–835 (2019).
PubMed
Google Scholar
4.
Taipale H, Reutfors J, Tanskanen A et al. Risk and risk factors for disability pension among patients with treatment resistant depression- a matched cohort study. BMC Psychiatry 20(1), 232 (2020).
PubMed
Google Scholar
5.
Lundberg J, Cars T, Lööv SÅ et al. Association of treatment-resistant depression with patient outcomes and health care resource utilization in a population-wide study. JAMA Psychiatry 80(2), 167–175 (2023).
PubMed
Google Scholar
6.
Greenberg PE, Fournier AA, Sisitsky T et al. The economic burden of adults with major depressive disorder in the United States (2010 and 2018). Pharmacoeconomics 39(6), 653–665 (2021).
PubMed
Google Scholar
7.
Anand A, Mathew SJ, Sanacora G et al. Ketamine versus ECT for nonpsychotic treatment-resistant major depression. N. Engl. J. Med. 388(25), 2315–2325 (2023).
PubMed
Google Scholar
•• Details the process and results of the ELEKT-D trial, the largest comparative effectiveness trial to date in the US, demonstrated that intravenous ketamine was noninferior to electroconvulsive therapy for nonpsychotic treatment-resistant depression.
9.
Espinoza RT, Kellner CH. Electroconvulsive therapy. N. Engl. J. Med. 386(7), 667–672 (2022).
PubMed
Google Scholar
10.
Berman RM, Cappiello A, Anand A et al. Antidepressant effects of ketamine in depressed patients. Biol. Psychiatry 47(4), 351–354 (2000).
PubMed
Google Scholar
11.
Allaire B, Skinner R, King G, Honeycutt A, Esposito D. An economic evaluation of reducing colorectal cancer surveillance intensity. J. Comp. Eff. Res. 11(2), 99–107 (2022).
PubMed
Google Scholar
12.
Boyer N, Skinner R, Breck A. An impact evaluation of an education bundle for patients at risk of developing venous thromboembolism. J. Comp. Eff. Res. 11(8), 563–574 (2022).
PubMed
Google Scholar
13.
Honeycutt A, Breck A, Bass S, Esposito D. Impact analysis of expanding anti-TNF therapy for Crohn's disease. J. Comp. Eff. Res. 11(2), 79–88 (2022).
PubMed
Google Scholar
14.
Skinner R, Breck A, Esposito D. An economic evaluation of teledermatology care delivery for chronic skin diseases. J. Comp. Eff. Res. 11(2), 67–77 (2022).
PubMed
Google Scholar
15.
Luccarelli J. Personal communication. (2024).
Google Scholar
16.
National Institute of Mental Health. Major depression. Accessed: 10 May 2024: https://www.nimh.nih.gov/health/statistics/major-depression
Google Scholar
17.
Ross EL, Zivin K, Maixner DF. Cost-effectiveness of electroconvulsive therapy vs pharmacotherapy/psychotherapy for treatment-resistant depression in the United States. JAMA Psychiatry 75(7), 713–722 (2018).
PubMed
Google Scholar
18.
Agency for Healthcare Research and Quality (AHRQ). Medical Expenditure Panel Survey (MEPS) (2016–2019). (Accessed: 27 September 2024). https://meps.ahrq.gov/mepsweb/?_gl=1*1fxc4u*_ga*OTIyODgyNjE3LjE3Mjc0NDk2NDc
Google Scholar
19.
Pilon D, Joshi K, Sheehan JJ et al. Burden of treatment-resistant depression in Medicare: a retrospective claims database analysis. PLOS One. 14(10), e0223255 (2019).
PubMed
Google Scholar
20.
Bureau of Labor Statistics (BLS). Employer costs for employee compensation – June 2024 USDL-24-1863. Bureau of Labor Statistics, Washington, DC, USA (10 September 2024).
Google Scholar
21.
AARP and National Alliance for Caregiving. Caregiving in the United States. 2020. (Accessed: 27 September 2024). https://www.aarp.org/pri/topics/ltss/family-caregiving/caregiving-in-the-united-states/
Google Scholar
22.
Frank RG, Glied SA. NB19-05: Changing Labor Markets and Mental Illness: Impacts on Work and Disability (2019). National Bureau of Economic Research, Cambridge, MA, USA, Available from: https://www.nber.org/programs-projects/projects-and-centers/retirement-and-disability-research-center/7569-nb19-05-changing-labor-markets-and-mental-illness-impacts-work-and-disability
Google Scholar
23.
Nordenskjöld A, von Knorring L, Ljung T, Carlborg A, Brus O, Engström I. Continuation electroconvulsive therapy with pharmacotherapy versus pharmacotherapy alone for prevention of relapse of depression: a randomized controlled trial. J. ECT 29(2), 86–92 (2013).
PubMed
Google Scholar
24.
Daly EJ, Trivedi MH, Janik A et al. Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA Psychiatry 76(9), 893–903 (2019).
PubMed
Google Scholar
25.
Brendle M, Ahuja S, Valle MD et al. Safety and effectiveness of intranasal esketamine for treatment-resistant depression: a real-world retrospective study. J. Comp. Eff. Res. 11(18), 1323–1336 (2022).
PubMed
Google Scholar
26.
Mathew SJ, Jha MK, Anand A. Choosing between ketamine and electroconvulsive therapy for outpatients with treatment-resistant depression-advantage ketamine? JAMA Psychiatry 80(12), 1187–1188 (2023).
PubMed
Google Scholar
•• This viewpoint article from the ELEKT-D authors discussed the clinical implication of their study findings in further detail.
27.
Osmind. Ketamine Billing Code Guide. (Accessed: 20 September 2024). https://www.osmind.org/knowledge-article/ketamine-billing-code-guide
Google Scholar
28.
Chrenek C, Duong B, Khullar A, McRee C, Thomas R, Swainson J. Use of ketamine for treatment resistant depression: updated review of literature and practical applications to a community ketamine program in Edmonton, Alberta, Canada. Front. Psychiatry 14, 1283733 (2024).
PubMed
Google Scholar
|