Ketamine Versus Electroconvulsive Therapy for Nonpsychotic Treatment-Resistant Depression: A Cost-Effectiveness Analysis
Michael Lebenbaum, Benoit H. Mulsant, Sagar V Parikh, Jason Fletcher, Jeffrey S. Hoch, Paul Kurdyak, Daniel M. Blumberger, Amit Anand, Manish K. Jha, Venkat Bhat
Psychiatric Services October 22, 2026 DOI: 10.1176/appi.ps.20240407 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Cost-effectiveness analysis (decision tree model) Peer reviewed |
|---|---|
| Interventions | Racemic ketamine Electroconvulsive therapy (ECT) |
| Duration | 29 weeks |
| Measures | Quality-adjusted life-years (QALYs) |
| Topics | Depression Esketamine Ketamine |
| Key points | In a modeled comparison over 29 weeks, racemic ketamine yielded 0.024 more QALYs than ECT for treatment-resistant depression while costing less from both health care (CA$1,663 less) and societal (CA$3,413 less) perspectives. Ketamine was cost-effective in nearly all one-way sensitivity analyses. The authors conclude that insurers covering all ECT costs should also cover all ketamine treatment costs. |
Abstract
Objective: Electroconvulsive therapy (ECT) is a highly effective intervention for treatment-resistant depression; however, its use has been limited partly because of concerns about cognitive side effects. Evidence for the sustained (>1 month) efficacy of ketamine versus ECT for treatment-resistant depression has only recently been demonstrated. This study aimed to examine the cost-effectiveness-that is, the costs and benefits measured as quality-adjusted life-years (QALYs)-of racemic ketamine versus that of ECT for treatment-resistant depression.
Methods: Using a decision tree model, the authors examined the incremental QALYs and costs of ketamine in comparison to ECT over 29 weeks from both health care and societal perspectives in Canada. Deterministic and probabilistic sensitivity analyses were used to account for uncertainty.
Results: Compared with ECT, ketamine resulted in higher health-related quality of life (incremental QALY=0.024) and lower costs from both a health care (CA$-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.
Citations in the library
Cites 5
- Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. New England Journal of Medicine May 24, 2023
- A Phase 2 Open Label Study of Efficacy, Safety, and Tolerability of SLS-002 (Intranasal Racemic Ketamine) in Adults with MDD at Imminent Risk of Suicide. Psychopharmacology Bulletin March 4, 2024
- Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT) The International Journal of Neuropsychopharmacology December 4, 2021
- Cost-effectiveness of psilocybin-assisted therapy for severe depression: exploratory findings from a decision analytic model. Psychological Medicine December 1, 2023
- Cost-effectiveness of esketamine nasal spray compared to intravenous ketamine for patients with treatment-resistant depression in the US utilizing clinical trial efficacy and real-world effectiveness estimates. Journal of Affective Disorders September 1, 2022