This cost-effectiveness analysis found that psilocybin-assisted therapy (PAT) for treatment-resistant depression (TRD) may offer economic value at $5,000 or less per treatment course, yielding an incremental cost-effectiveness ratio of $117,517 per QALY gained over 12 months, with cost-effectiveness highly sensitive to treatment price (95% probability at $3,000 vs 1% at $10,000).
Abstract of Psilocybin-assisted therapy for treatment-resistant depression in the US
“Psilocybin-assisted therapy (PAT) has been shown in early trials to reduce the symptoms of treatment-resistant depression (TRD). This study evaluated the cost-effectiveness of PAT as a third-line treatment for major depressive disorder compared to standard of care (SOC). We used an individual-level, probabilistic simulation model that portrays representative US adults with TRD who receive SOC (pharmacotherapy, psychotherapy, electroconvulsive therapy, and esketamine nasal spray) and PAT over 12 months. We assumed the total cost of PAT was $5000, which we varied in sensitivity analyses ($3000–20,000). We calculated total costs, health effects (in terms of quality-adjusted life years [QALYs] gained), and incremental cost-effectiveness ratio (ICER) from limited healthcare and societal perspectives. PAT leads to an additional 0.031 QALYs and $3639 costs compared to SOC over 12 months, giving an ICER of $117,517 per QALY gained from a limited healthcare perspective. Using a $150,000 cost-effectiveness threshold, PAT had a 75% probability of being the cost-effective choice, and it was associated with a lower expected loss than SOC ($301 vs. $1307). Results were sensitive to uncertainty in model parameters, particularly the cost of PAT. PAT had a 1% probability of being cost-effective when its overall costs were $10,000 and 95% when its costs were $3000. This cost-effectiveness analysis found that when its costs are $5000 or less, PAT may offer economic value compared to available TRD treatments. Future studies can explore ways to reduce the cost of PAT and to understand its long-term effectiveness in maintaining remission and reducing the risk of relapse.“
Authors: Anton L. V. Avanceña, Linh Vuong, James G. Kahn & Elliot Marseille
Summary of Psilocybin-assisted therapy for treatment-resistant depression in the US
Avanceña and colleagues assess whether psilocybin-assisted therapy (PAT) for treatment-resistant depression (TRD) delivers good value for money in the United States when used as a third-line option for major depressive disorder (MDD). TRD carries higher mortality and markedly higher healthcare and societal costs than responsive MDD. Early clinical trials with psilocybin have shown clinically meaningful remission rates in MDD and TRD, but PAT is resource-intensive: protocols commonly involve multiple preparation and integration sessions plus a supervised dosing day with two trained facilitators, in line with U.S. Food and Drug Administration (FDA) expectations for monitoring. Against this backdrop, the authors develop a cost-effectiveness model to compare one-dose PAT with the standard of care (SOC) mix used at third line in U.S. practice (pharmacotherapy ± psychotherapy, electroconvulsive therapy [ECT], and esketamine nasal spray).
The introduction highlights the evidence base motivating the model inputs: randomised controlled trials (RCTs) in MDD and TRD have reported remission rates after a single 25-mg psilocybin dose with psychosocial support that exceed those seen with standard third-line antidepressants. At the same time, PAT requires upfront therapist time and clinical infrastructure. Because head-to-head TRD comparisons are limited and long-term psilocybin outcomes remain uncertain, a model-based economic evaluation is used to estimate cost-effectiveness over 12 months and to identify the key drivers (e.g., total PAT cost, remission and relapse rates) that determine whether PAT is likely to be an efficient use of resources under conventional U.S. cost-effectiveness thresholds.
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https://doi.org/10.1038/s41398-025-03556-4
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Cite this paper (APA)
Avanceña, A. L., Vuong, L., Kahn, J. G., & Marseille, E. (2025). Psilocybin-assisted therapy for treatment-resistant depression in the US: a model-based cost-effectiveness analysis. Translational Psychiatry, 15(1), 330.
Study details
Compounds studied
Psilocybin
Topics studied
Economics
Treatment-Resistant Depression
Depression
Study characteristics
Theory Building