This cost-utility analysis, alongside a randomized controlled trial (n=174), compared subcutaneous ketamine (twice-weekly for 4 weeks) with midazolam in treatment-resistant depression. Including midazolam costs, ketamine raised QALYs (0.435 vs 0.352) and was dominant with an 89–91 % chance of costing < $50 000/QALY, but once these comparator costs were excluded ketamine was no longer cost-effective (ICER ≈ $108 500–$251 250/QALY, ≤ 5 % probability).
Abstract of Economic evaluation of subcutaneous ketamine injections for TRD
“Background Ketamine is effective for treatment resistant depression (TRD); but cost-effectiveness evidence remains limited.
Aims To evaluate the cost-effectiveness of subcutaneous ketamine for TRD from health sector and societal perspectives.
Methods A cost-utility analysis alongside the KADS randomised controlled trial (RCT) involved 174 participants receiving ketamine or midazolam (active control) twice weekly for 4 weeks. Healthcare resource use, transportation, carer time and lost productivity data were collected via self-reported questionnaire at baseline, end of RCT (week 4) and RCT 4-week follow-up (week 8). Quality-adjusted life years (QALYs) were calculated using AQoL-8D utility values. Initial dosing was fixed (cohort 1) and changed to response-guided dosing (cohort 2). Base-case 1 included control arm treatment costs; base-case 2 excluded these costs.
Results At end of RCT, cohort 2 utility values were significantly higher for ketamine than the control treatment (0.435 vs. 0.352; p < 0.05). Health sector incremental cost-effectiveness ratios (ICERs) in base-case 1 indicated ketamine was dominant (less costly, more effective) with probabilities of falling below $50,000/QALY of 89 % (end of RCT) and 91 % (total across 8-weeks). Societal perspective probabilities were lower (30–32 %). In base-case 2, ketamine was not cost-effective (ICERs: $251,250/QALY at end of RCT; $108,500/QALY across 8-weeks), with minimal probabilities (0–5 %) of falling below $50,000/QALY.
Conclusions The initial four-week ketamine treatment phase appeared cost-effective from a health sector perspective when including control arm costs, although societal perspective results were less favourable. Excluding control treatment costs highlighted substantial uncertainty, emphasising the importance of selecting an appropriate comparator for an economic evaluation.”
Authors: Mary Lou Chatterton, Johana Kevin Perez, Thao Thai, Jan Faller, Colleen K. Loo, Nick Glozier, David Barton, Bernhard T. Baune, Natalie T. Mills, Paul B. Fitzgerald, Paul Glue, Shanthi Sarma, Dusan Hadzi-Pavlovic, Vanessa Dong, Donel Martin, Philip B. Mitchell, Michael Berk, Gregory Carter, Maree Hackett, Sean Hood, Andrew A. Somogyi, Anthony Rodgers & Cathrine Mihalopoulos
Summary of Economic evaluation of subcutaneous ketamine injections for TRD
Treatment-resistant depression (TRD) affects roughly one-third of people with major depressive disorder and imposes heavy personal and economic burdens. Racemic ketamine, an injectable mixture of R- and S-ketamine, has shown rapid antidepressant effects, yet almost all economic work has centred on intranasal esketamine. Chatterton and colleagues therefore set out to determine whether a four-week course of subcutaneous ketamine offers value for money compared with an active control (midazolam). Their within-trial economic evaluation, embedded in the Phase III KADS randomised controlled trial, adopts both a health-sector and a broader societal lens.
Methods
Study design and participants
Find this paper
https://doi.org/10.1016/j.jad.2025.119502
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Cite this paper (APA)
Chatterton, M. L., Perez, J. K., Thai, T., Faller, J., Loo, C. K., Glozier, N., ... & Mihalopoulos, C. (2025). Economic evaluation of subcutaneous ketamine injections for treatment resistant depression: A randomised, double-blind, active-controlled trial–The KADS study. Journal of Affective Disorders, 119502.
Study details
Compounds studied
Ketamine
Placebo
Topics studied
Depression
Treatment-Resistant Depression
Economics
Study characteristics
Placebo-Controlled
Active Placebo
Double-Blind
Randomized
Re-analysis
Participants
174
Humans
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