Over 29 weeks, ketamine therapy is more cost-effective than electroconvulsive therapy (ECT) for treatment-resistant depression—for both individual patients and society as a whole, according to a report published today in Psychiatric Services.Why It’s Relevant
While ECT is a highly effective intervention for treatment-resistant depression, utilization is low in part because of patient concerns about adverse cognitive effects as well as the resources required (for example, needing a psychiatrist and anesthesiologist for each procedure). Relatedly, the short-term efficacy of ketamine for treatment-resistant depression has been well established, but there have been no longer-term studies assessing both its effectiveness and cost.
By the Numbers
- Researchers calculated the effectiveness of ketamine and ECT using data from the ELEKT-D clinical trial involving 365 patients with nonpsychotic depression. Health care costs were obtained from a prior study conducted in Ontario that examined the cost of outpatient visits and medication for treatment-resistant depression.
- Patients receiving ketamine had an additional .024 years of quality life and saved $1,663 dollars (Canadian) in treatment costs on average compared with those receiving ECT.
- Societal costs of ketamine were also lower, resulting in incremental cost savings of $3,413.
- These results suggest that ketamine was cost-effective relative to ECT because of the higher direct costs of ECT, such as greater equipment costs, staff requirements, and number of treatments, along with associated indirect costs.
The Other Side
This analysis was done on the assumption that ketamine would be covered by public health services the same as ECT; if each ketamine session costs around $1,000 (an average amount in private clinics), then it is no longer cost-effective. Additionally, nearly 90% of participants in ELEKT-D initiated treatment as outpatients, so these estimates may not apply to patients with more severe depression that requires hospitalization—nor for those with psychotic depression, for which ECT is highly effective.
Takeaway Message
While continued research is needed to assess the cost-effectiveness of ketamine beyond 29 weeks, the researchers said that their results support efforts to improve access to ketamine: “Health insurance plans that cover all costs of ECT should also cover all costs of ketamine treatment for treatment-resistant depression.”
Related Information
Source
Michael Lebenbaum, et. al. Ketamine versus electroconvulsive therapy for nonpsychotic treatment-resistant depression: a cost-effectiveness analysis. Psychiatric Services. Published October 22, 2026. doi:10.1176/appi.ps.20240407
(Image: Getty Images/iStock/Jeniffer Fontan)
