The Costs and Health Benefits of Expanded Access to MDMA-assisted Therapy for Chronic and Severe PTSD in the USA: A Modeling Study
Anton L. V. Avanceña, J. Kahn, E. Marseille
Clinical drug investigation March 1, 2022 DOI: 10.1007/s40261-022-01122-0 via Semantic Scholar
Summary
Expanding access to MDMA-assisted psychotherapy (MDMA-AT) for US patients with chronic and severe PTSD would likely provide substantial health and financial benefits. A decision-analytic model compared three coverage targets (25%, 50%, and 75% of eligible patients) against standard care. All three targets were cost-saving and projected to avert 43,618 to 106,932 deaths and gain 3.3 to 8.2 million quality-adjusted life years over 10 years. Sensitivity analyses confirmed that MDMA-AT remained dominant under various assumptions, though the precise magnitude of benefits depends on the number of eligible patients and other inputs.
Study at a glance
| Characteristics | Decision-analytic model Peer reviewed |
|---|---|
| Population | Eligible US patients with chronic and severe PTSD |
| Keywords | Medicine Psychology Economics |
| Citations | 19 |
| Key finding | Expanding MDMA-AT to 25–75% of eligible patients is projected to be cost-saving compared to standard of care, averting tens of thousands of deaths and gaining millions of quality-adjusted life years. |
Abstract
Intensive psychotherapy assisted with 3,4-methylenedioxymethamphetamine (MDMA-AT) was shown in Phase 3 clinical trials to substantially reduce post-traumatic stress disorder (PTSD) symptoms compared to psychotherapy with placebo. This study estimates potential costs, health benefits, and net savings of expanding access to MDMA-AT to eligible US patients with chronic and severe PTSD. Using a decision-analytic model, we compared the costs, deaths averted, and quality-adjusted life years (QALYs) gained of three, 10-year MDMA-AT coverage targets (25%, 50%, and 75%) compared to providing standard of care to the same number of eligible patients with chronic and severe PTSD. We used a payer perspective and discounted costs (in US$) and QALYs to 2020. We conducted one-way, scenario, and probabilistic sensitivity analyses and calculated the net monetary value of MDMA-AT using a cost-effectiveness threshold of $100,000 per QALY gained. Expanding access to MDMA-AT to 25–75% of eligible patients is projected to avert 43,618–106,932 deaths and gain 3.3–8.2 million QALYs. All three treatment targets are dominant or cost-saving compared to standard of care. Our sensitivity analyses found that accounting for parameter uncertainty and changes in various assumptions did not alter the main finding—MDMA-AT is dominant compared to standard of care. Expanding access to MDMA-AT to patients with chronic and severe PTSD will provide substantial health and financial benefits. The precise magnitude is uncertain and will depend on the number of eligible patients and other inputs.