Researchers in the United Kingdom recently conducted a study to determine if psychedelic-assisted psychotherapy could be a more cost-effective option than more traditional forms of psychotherapy for those who experience depression. The results suggested that this unique approach could be a cost-effective choice, but only under certain circumstances. The research was published in the journal Psychological Medicine.
Depression is a widespread mental health problem that affects millions of people across the globe. Even though there are many available treatments, a significant number of people with depression don’t see an improvement with standard therapies. A more severe form of depression, known as treatment-resistant depression (TRD), is particularly hard to treat and can greatly impact a person’s quality of life. Recent research has hinted that therapy with the help of psilocybin, a psychedelic, could be a promising solution for TRD. Yet, the cost-effectiveness of this approach hasn’t been fully understood.
Psilocybin-assisted therapy is a form of mental health treatment that combines the use psilocybin, found naturally in certain types of so-called “magic” mushrooms, with psychological support or psychotherapy. Psilocybin-assisted therapy is a promising approach being studied for its potential benefits in treating conditions such as depression, anxiety, post-traumatic stress disorder, and addiction.
“Effective and relatively inexpensive treatments for depression exist, but a significant proportion of people with depression will have an inadequate treatment response and relapse rates can be high,” the authors of the new study wrote.
The researchers used a computer model to predict the cost-effectiveness of psilocybin-assisted therapy for TRD over the course of six months. The simulation was based on data from existing clinical studies and included various assumptions about the effectiveness and costs of psilocybin-assisted therapy. The model compared the costs and benefits (improvements in quality of life) of psilocybin-assisted therapy with those of conventional treatments for TRD, such as antidepressant medications and psychotherapy.
Over this six-month period, the researchers found that the highest increase in quality of life was for patients who received psilocybin-assisted therapy (a score of 0.310). This was followed by a combination of medication and cognitive-behavioral therapy (CBT) (0.287), then CBT alone (0.283), and finally medication alone (0.276).
The cost of psilocybin ranged from £400 to £2000 per person. The total expected healthcare costs for psilocybin therapy ranged from £6255 to £7775, which was higher compared to conventional medication alone (£3700), CBT alone (£4405), and a combination of medication and CBT (£4351).
The researchers found that the cost of therapist support was a major factor in the cost-effectiveness of psilocybin-assisted therapy. If the cost of therapist support was halved and the cost of psilocybin was below £800, then psilocybin-assisted therapy became more cost-effective compared to combined therapy, conventional medication alone, and CBT alone.
“While psilocybin and other psychedelic therapies have been identified as potentially useful treatment options, there are clear challenges in their application. Firstly, psychedelics (including psilocybin) are controlled substances under Schedule 1 of the [U.K.s’ Misuse of Drugs Act 1971] and approval for their use in research studies must be specifically obtained. This adds considerable costs at present that will reduce once/if they become approved medicines,” the researchers explained.
“Furthermore, it is recognised that support for patients is required prior to, during, and after the administration of psilocybin, which has large implications for cost-effectiveness. Our modelling study has indicated that if the level of support is at the higher end, then this adversely affects cost-effectiveness,” the researchers added. However, they said, in routine practice it is unlikely that psilocybin-assisted therapy would require 38 hours of a therapist’s time, which is what was provided in the clinical trials used for their models.
However, there are some caveats to this study. First, it relied on data from existing studies, which were limited and had short follow-up times. Second, the cost estimates were based on older studies, and the cost and effectiveness of treatments may have changed over time. Third, the study didn’t take into account possible negative effects of psychedelic-assisted therapy, which could impact its cost-effectiveness. Lastly, the study was based on healthcare costs in the UK, so other countries might have different costs that could affect the choice and success of therapy.
“This study provides preliminary information about the potential cost-effectiveness of psilocybin for treating severe depression,” the researchers concluded. “The results indicate positive findings from a societal perspective, which may identify and facilitate more cost-effective approaches to psilocybin therapy. It is essential to better understand who the drug should be prioritised for in terms of treatment resistance and how much therapist support is required.”
The study, “Cost-effectiveness of psilocybin-assisted therapy for severe depression: exploratory findings from a decision analytic model,” was authored by Paul McCrone, Henry Fisher, Clare Knight, Rebecca Harding, Anne K. Schlag, David J. Nutt, and Joanna C. Neill.