Presentation (CTI)

OBJECTIVES: Treatment-resistant depression (TRD) imposes a substantial economic burden and presents a significant clinical challenge. While psilocybin-assisted therapy (PAT) has demonstrated clinical promise, its long-term economic value remains unclear. This study evaluated the cost-effectiveness of PAT compared with standard of care (SoC) for TRD from a U.S. healthcare perspective.
METHODS: A Markov model was developed to simulate patient transitions among health states (remission, response, non-response, and relapse) using 6-week cycles, corresponding to the longest duration for which PAT efficacy data are currently available. Model parameters were derived from randomized controlled trials and relevant published literature. Outcomes included quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses examined uncertainty related to key model parameters, dosing regimens, retreatment strategies, and psilocybin prices. Scenario analyses extended the time horizon up to 30 years to evaluate long-term treatment persistence and the impact of efficacy waning.
RESULTS: Compared with SoC, PAT was more effective and less costly, yielding approximately $7,000 in cost savings and a gain of 0.10 QALYs per patient. These economic advantages persisted across variations in key parameters, dosing strategies, retreatment assumptions, and psilocybin prices in sensitivity analyses. Probabilistic sensitivity analyses indicated an 82.0% probability that PAT would be cost-effective at a willingness-to-pay (WTP) threshold of $50,000/QALY, with PAT remaining the optimal strategy across WTP thresholds up to $200,000/QALY. Extending the time horizon to 30 years increased cumulative savings to $215,900 and total QALY gains to 9.87. PAT remained cost-effective under all assumptions regarding long-term efficacy waning.
CONCLUSIONS: PAT may represent a cost-effective treatment option for TRD, primarily driven by early clinical benefits that offset downstream chronic care costs. Longitudinal real-world evidence is needed to validate these findings and inform the sustainable integration of PAT into clinical practice.