Daily Intravenous Ketamine for Treatment-Resistant Depression: a Cost-Effectiveness Analysis Alongside the Clinical Trail
Author(s)
Keerati Pattanaseri, MD1, Chayanis Kositamongkol, PharmD, MSc2, Pochamana Phisalprapa, MD, PhD2, Juthawadee Lortrakul, MD1, Kankamol Jaisin, MD1, Maytinee Srifuengfung, MD1, Naratip Sanguanpanich, MD1, Natee Viravan, MD1, Pornjira Pariwatcharakul, MD1, Wattanan Makarasara, MD3, Woraphat Ratta-apha, MD1;
1Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Psychiatry, Bangkok, Thailand, 2Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Medicine, Bangkok, Thailand, 3Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Anesthesiology, Bangkok, Thailand
1Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Psychiatry, Bangkok, Thailand, 2Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Medicine, Bangkok, Thailand, 3Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Anesthesiology, Bangkok, Thailand
Presentation Documents
OBJECTIVES: We aimed to conduct a cost-effectiveness analysis alongside a randomized controlled trial (RCT) evaluating the use of daily intravenous ketamine over three days for treatment-resistant depression (TDR) compared to an active placebo.
METHODS: We utilized person-level data from the RCT conducted at Siriraj Hospital, Mahidol Univesity, Thailand, to assess the cost-effectiveness of ketamine compared to midazolam, the active placebo. Both treatments were administered intravenously over three consecutive days during a four-day hospitalization, with a follow-up period of one month. The effectiveness of each treatment for TDR was measured in quality-adjusted life-years (QALYs) using the EuroQol 5-Dimension 5-Level questionnaire, the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Clinical Global Impression-Severity (CGI-S). Costs associated with outpatient and inpatient visits were calculated from a societal perspective, encompassing both direct medical costs (treatment for TDR and any adverse events) and direct non-medical costs. A probabilistic sensitivity analysis was performed.
RESULTS: Among the 20 participants included in the RCT, 18 provided complete data for the analysis. The number of participants in the ketamine and midazolam groups was equal. Median costs of the ketamine and the midazolam groups were 374 USD (interquartile range [IQR] 281-577) and 291 USD (IQR 244-525), respectively. Average QALYs were 0.063±0.006 for ketamine and 0.061±0.009 for midazolam. The incremental cost-effectiveness ratios (ICERs) for ketamine compared to midazolam were 154,470 USD/QALY gained, 39 USD/1 point decrease in MADRS, and 225 USD/1 point decrease in CGI-S. The ICER per one remission achieved was 1,352 USD. Sensitivity analysis indicated an 8.2% probability of ketamine being cost-effective at Thailand's willingness-to-pay threshold of 4,619 USD/QALY gained.
CONCLUSIONS: This study highlights the increased effectiveness of ketamine at its higher cost, compared to midazolam. Variability in the cost-effectiveness of ketamine for TDR across different outcome measures was observed, underscoring the need for further research to elucidate its optimal regimen and economic implications.
METHODS: We utilized person-level data from the RCT conducted at Siriraj Hospital, Mahidol Univesity, Thailand, to assess the cost-effectiveness of ketamine compared to midazolam, the active placebo. Both treatments were administered intravenously over three consecutive days during a four-day hospitalization, with a follow-up period of one month. The effectiveness of each treatment for TDR was measured in quality-adjusted life-years (QALYs) using the EuroQol 5-Dimension 5-Level questionnaire, the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Clinical Global Impression-Severity (CGI-S). Costs associated with outpatient and inpatient visits were calculated from a societal perspective, encompassing both direct medical costs (treatment for TDR and any adverse events) and direct non-medical costs. A probabilistic sensitivity analysis was performed.
RESULTS: Among the 20 participants included in the RCT, 18 provided complete data for the analysis. The number of participants in the ketamine and midazolam groups was equal. Median costs of the ketamine and the midazolam groups were 374 USD (interquartile range [IQR] 281-577) and 291 USD (IQR 244-525), respectively. Average QALYs were 0.063±0.006 for ketamine and 0.061±0.009 for midazolam. The incremental cost-effectiveness ratios (ICERs) for ketamine compared to midazolam were 154,470 USD/QALY gained, 39 USD/1 point decrease in MADRS, and 225 USD/1 point decrease in CGI-S. The ICER per one remission achieved was 1,352 USD. Sensitivity analysis indicated an 8.2% probability of ketamine being cost-effective at Thailand's willingness-to-pay threshold of 4,619 USD/QALY gained.
CONCLUSIONS: This study highlights the increased effectiveness of ketamine at its higher cost, compared to midazolam. Variability in the cost-effectiveness of ketamine for TDR across different outcome measures was observed, underscoring the need for further research to elucidate its optimal regimen and economic implications.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE441
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
SDC: Mental Health (including addition)