Ketamine Versus Electroconvulsive Therapy for Nonpsychotic Treatment-Resistant Depression: A Cost-Effectiveness Analysis.

OBJECTIVE

Electroconvulsive therapy (ECT) is a highly effective intervention for treatment-resistant depression; however, its use has been limited partly because of concerns about cognitive side effects. Evidence for the sustained (>1 month) efficacy of ketamine versus ECT for treatment-resistant depression has only recently been demonstrated. This study aimed to examine the cost-effectiveness-that is, the costs and benefits measured as quality-adjusted life-years (QALYs)-of racemic ketamine versus that of ECT for treatment-resistant depression.

METHODS

Using a decision tree model, the authors examined the incremental QALYs and costs of ketamine in comparison to ECT over 29 weeks from both health care and societal perspectives in Canada. Deterministic and probabilistic sensitivity analyses were used to account for uncertainty.

RESULTS

Compared with ECT, ketamine resulted in higher health-related quality of life (incremental QALY=0.024) and lower costs from both a health care (CA$-1,663) and a societal (incremental cost=-$3,413) perspective. In nearly all one-way sensitivity analyses, ketamine was found to be cost-effective relative to ECT.

CONCLUSIONS

Ketamine provided additional QALYs while saving costs relative to ECT for treatment-resistant depression. Health insurance plans that cover all costs of ECT should also cover all costs of ketamine treatment for treatment-resistant depression.