Lu Thanh, D'Angelo Sophia, Tayebali Zohra, Dempsey Matthew, Giombi Kristen, Khavjou Olga
RTI International, Research Triangle Park, NC 27709, USA.
J Comp Eff Res. 2025 Jun;14(6):e240233. doi: 10.57264/cer-2024-0233. Epub 2025 May 22.
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. 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. 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. 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.
本研究旨在通过为患有非精神病性难治性抑郁症（TRD）和中度至重度抑郁症的美国患者提供静脉注射氯胺酮，评估扩大氯胺酮可及性相对于电休克疗法（ECT）的经济影响。使用一个具有来自随机试验关键参数的人群水平马尔可夫模拟模型，来模拟在5年时间内用静脉注射氯胺酮与ECT治疗TRD的经济影响。健康状态包括急性治疗阶段抑郁症的缓解以及维持阶段的持续治疗和复发。该模型从患者、护理人员、支付方和社会角度估计了与医疗保健利用相关的成本（直接成本）和时间损失（间接成本）。通过单向敏感性分析、概率敏感性分析和情景分析评估模型的不确定性。在第1年，我们的模型纳入了350,000名符合条件的患者。在第2年至第5年，我们的模型每年新增11,296名符合条件的患者。预计扩大氯胺酮可及性以治疗TRD，将使第1年接受治疗的患者数量增加75,000名，在随后几年每年增加4292名。在5年期间，扩大氯胺酮可及性将带来每年8.282亿美元的净社会储蓄（患者节省9530万美元，支付方节省7.437亿美元）。然而，扩大氯胺酮可及性每年将给护理人员时间带来额外1080万美元的负担。对于患有TRD和中度至重度抑郁症的美国患者，氯胺酮在改善抑郁症状方面可能是一种相对于ECT非劣效的治疗方法。扩大氯胺酮治疗的可及性将为患者、支付方和社会带来净储蓄。
