A case study on ketamine highlights the persistent obstacles preventing individuals with treatment-resistant depression from accessing the treatment.

Despite its life-changing potential, researchers say challenges still impede affordable treatments, proposing solutions to overcome these issues.

The article published in the Australian & New Zealand Journal of Psychiatry by a team of medical researchers, including UNSW Sydney, Black Dog Institute, and The George Institute for Global Health, says that despite over 20 years of evidence supporting the effectiveness of generic ketamine, public funding for research and patient access has been slow, poorly coordinated, and underfunded. 

Additionally, the lack of commercial incentives and public-private partnerships has hindered research and development of generic ketamine.

This has resulted in a significant disparity in accessibility and cost between ketamine-based depression treatments. 

The patented intranasal s-enantiomeric ketamine, Spravato, costs between $500 to $900 per dose, while generic ketamine is priced at approximately $5 to $20 per dose. 

The high cost of Spravato has led to its rejection for public reimbursement, rendering it largely inaccessible to Australian patients.

On the other hand, generic ketamine, although cost-effective, faces regulatory and financial barriers, particularly the ongoing costs associated with monitoring patients for at least two hours after each dose. 

As multiple doses are necessary for effective treatment, these expenses become prohibitive for many.

This issue extends beyond ketamine, as the article predicts a similar fate for upcoming psychedelic-assisted psychotherapy treatments entering the mental health treatment arena. 

Without systemic interventions, the underutilisation of low-cost, effective solutions persists, depriving patients of access to treatment while threatening to inflate healthcare costs.

Professor Anthony Rodgers of The George Institute and his colleagues propose a range of solutions, including providing better commercial incentives, increasing funding for integrated research, reducing regulatory hurdles, streamlining clinical trial procedures, and promoting collaboration across sectors and borders. 

They urge all stakeholders to work together to create a conducive ecosystem for repurposing off-patent medicines.

Researchers also say there is a need for Medicare funding for the treatment process, highlighting systemic barriers that block the process due to a lack of commercial interest in repurposing low-cost, off-patent ketamine. 

The authors and their institutions plan to submit an application to Medicare to secure government support for ketamine treatment for severe depression within the public health system, aiming to make this life-changing treatment more accessible to those in need.