Cost-effectiveness of psilocybin-assisted therapy for severe depression: exploratory findings from a decision analytic model
Using a 6‑month decision analytic model, the authors found psilocybin-assisted psychotherapy produced the highest QALYs but higher healthcare costs, and could be cost‑effective versus medication and CBT if therapist support costs were halved and psilocybin were priced at about £400–£800 per person. From a societal perspective PAP appeared more favourable, though longer‑term outcome data are needed.
Abstract
Background
There is growing evidence to support the use of the psychedelic drug psilocybin for difficult-to-treat depression. This paper compares the cost-effectiveness of psilocybin-assisted psychotherapy (PAP) with conventional medication, cognitive behavioural therapy (CBT), and the combination of conventional medication and CBT.
Methods
A decision model simulated patient events (response, remission, and relapse) following treatment. Data on probabilities, costs and quality-adjusted life years (QALYs) were derived from previous studies or from best estimates. Expected healthcare and societal costs and QALYs over a 6-month time period were calculated. Sensitivity analyses were used to address uncertainty in parameter estimates.
Results
The expected healthcare cost of PAP varied from £6132 to £7652 depending on the price of psilocybin. This compares to £3528 for conventional medication alone, £4250 for CBT alone, and £4197 for their combination. QALYs were highest for psilocybin (0.310), followed by CBT alone (0.283), conventional medication alone (0.278), and their combination (0.287). Psilocybin was shown to be cost-effective compared to the other therapies when the cost of therapist support was reduced by 50% and the psilocybin price was reduced from its initial value to £400 to £800 per person. From a societal perspective, psilocybin had improved cost-effectiveness compared to a healthcare perspective.
Conclusions
Psilocybin has the potential to be a cost-effective therapy for severe depression. This depends on the level of psychological support that is given to patients receiving psilocybin and the price of the drug itself. Further data on long-term outcomes are required to improve the evidence base.
Research Summary of 'Cost-effectiveness of psilocybin-assisted therapy for severe depression: exploratory findings from a decision analytic model'
Introduction
Major depressive disorder (MDD) causes substantial personal and societal burden and a sizeable minority of patients do not achieve sustained recovery after standard treatments. Interest has resurged in psychedelic-assisted therapies, and psilocybin-assisted psychotherapy (PAP) has shown promising results in several small, short-term studies for moderate to severe depression, including some work in populations with comorbid medical or psychiatric conditions. PAP differs from most pharmacotherapies because it is typically administered only once or twice per episode and is delivered together with intensive psychotherapeutic support; both the staffing intensity and the regulatory status of psilocybin (Schedule 1 in the UK) affect its likely cost profile. Mccrone and colleagues set out to provide a first exploratory economic evaluation of PAP versus three comparators: conventional antidepressant medication (escitalopram), cognitive behavioural therapy (CBT), and the combination of medication plus CBT. The study used a short-term decision analytic model to estimate healthcare and societal costs and quality-adjusted life years (QALYs) over six months, and applied NICE-style incremental cost-effectiveness thresholds (£20 000–£30 000 per QALY) to assess whether PAP could be considered cost-effective under plausible scenarios of drug price, therapist support intensity, and clinical effectiveness.
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Study Details
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McCrone, P., Fisher, H., Knight, C., Harding, R., Schlag, A. K., Nutt, D. J., & Neill, J. C. (2023). Cost-effectiveness of psilocybin-assisted therapy for severe depression: exploratory findings from a decision analytic model. Psychological Medicine, 53(16), 7619-7626. https://doi.org/10.1017/S0033291723001411
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Rosenblat, J. D., Meshkat, S., Doyle, Z. et al. · Med (2024)
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