研究称难治性抑郁中氯胺酮比ECT更具成本效益

一项成本效益比较

《Psychiatric Services》10月22日刊出一项成本效益分析，比较氯胺酮与电休克治疗（ECT）用于非精神病性难治性抑郁的经济性。报告结论是：在29周的观察期内，无论从患者个人还是社会整体角度看，氯胺酮治疗都更具成本效益。

这项分析并非新的疗效试验。效果数据来自ELEKT-D临床试验，共纳入365名非精神病性抑郁患者；成本数据则取自安大略省一项既往研究，该研究考察了难治性抑郁的门诊就诊与用药费用。研究者把两者结合，计算两种治疗在效果与花费上的差异。

数字说明了什么

按报告给出的结果，接受氯胺酮治疗的患者比接受ECT者平均多获得0.024个质量调整生命年，同时治疗费用平均少1663加元。若把社会成本也计入，氯胺酮带来的增量节省为3413加元。

研究者把这一差异归因于ECT的直接成本更高，例如设备、人员配置和治疗次数更多，以及相关的间接成本。这里需要留意，0.024个质量调整生命年是一个很小的增量，报告并未把它描述为疗效上的大幅优势，成本优势主要来自ECT一侧的开支结构。

结论成立的前提

这项分析有一个关键假设：氯胺酮与ECT一样由公共医疗服务覆盖。报告明确指出，如果每次氯胺酮治疗按私人诊所约1000加元的均价计算，它就不再具有成本效益。也就是说，结论依赖于支付方式，而不只是治疗本身。

适用人群也有限。ELEKT-D中近90%的参与者以门诊身份开始治疗，因此这些估算可能不适用于需要住院的更严重抑郁患者；对于精神病性抑郁，报告也提示不适用，因为ECT在该人群中高度有效。此外，研究者表示仍需继续评估29周之后的成本效益。

研究者主张与背景

报告在背景中解释了为什么值得比较：ECT对难治性抑郁高度有效，但使用率偏低，部分原因是患者担心认知方面的不良反应，以及每次操作需要精神科医生和麻醉科医生等资源。氯胺酮的短期疗效已被较多确立，但此前缺少同时评估其效果与成本的较长周期研究。

基于上述结果，研究者主张改善氯胺酮的可及性，并提出覆盖ECT全部费用的医疗保险计划，也应为难治性抑郁的氯胺酮治疗覆盖全部费用。这是研究者的政策主张，属于对成本效益结果的延伸解读，而非该分析直接检验的结论。

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)