IM Ketamine: A Cost-Effective Alternative for TRD

IM Ketamine Matches IN Esketamine in Treating TRD

Intramuscular (IM) ketamine has been demonstrated to be non-inferior to intranasal (IN) esketamine for treating treatment-resistant depression (TRD), according to a study conducted at the Veterans Affairs (VA) San Diego. This real-world evidence was gathered from a retrospective, observational cohort study involving 179 veterans diagnosed with TRD. The study's primary outcome was the change in depressive symptoms, measured by the Patient Health Questionnaire-9 (PHQ-9), with a non-inferiority margin set at -1.25 points.

Mechanism and Context of the Study

The study employed linear mixed-effects models to assess the effectiveness of both treatments. Participants received eight treatments of either IN esketamine or IM ketamine. The results showed a baseline-adjusted estimated marginal mean PHQ-9 difference of 0.04 points, with a 95% confidence interval ranging from -1.21 to 1.29, indicating that IM ketamine is indeed non-inferior to IN esketamine in reducing depressive symptoms. Additionally, reductions in Post-Traumatic Stress Disorder (PTSD) symptoms were also found to be non-inferior.

Policy and Research Implications

This study's findings could significantly influence clinical practice and healthcare policy by highlighting a more cost-effective treatment option for TRD. The total cost per eight-treatment course was $6069 for IN esketamine compared to just $647 for IM ketamine, primarily due to the high cost of IN esketamine. This substantial cost difference suggests that IM ketamine could be a high-value alternative, potentially expanding access to psychiatric care for patients with TRD who might otherwise be unable to afford treatment.

Risks and Unknowns

While the study presents promising results, it is important to consider potential risks and unknowns. The incidence of sentinel adverse events was comparable between the two treatments, with no significant differences in emergency department visits or hospitalizations. However, long-term safety data for IM ketamine is still limited, and further research is needed to fully understand its long-term effects and optimal dosing strategies.

Looking Forward

The findings from this study suggest a promising future for IM ketamine as a cost-effective treatment for TRD. By offering a cheaper alternative to IN esketamine, IM ketamine could play a crucial role in improving access to ketamine treatment, particularly in resource-limited settings. As healthcare systems continue to seek cost-effective solutions, IM ketamine's potential to lower treatment costs could lead to broader adoption and integration into standard psychiatric care protocols.