Study reveals barriers to accessing low-cost ketamine

Medical researchers from UNSW Sydney, Black Dog Institute and The George Institute for Global Health have investigated why many patients with treatment-resistant depression are unable to access affordable, effective medications like generic ketamine.

In an article published in the Australian & New Zealand Journal of Psychiatry, the multidisciplinary team provided insights into why treatments like generic ketamine are being ignored in favour of more expensive alternatives that aren’t necessarily better.

Currently, a patented, intranasal s-enantiomeric ketamine formulation, Spravato, is priced at around $500 to $900 per dose — a high cost that has led to it being rejected for public reimbursement three times and thus remaining largely inaccessible for Australian patients. In contrast, generic ketamine stands at about $5 to $20 per dose, but the treatment remains unapproved and underutilised due to regulatory and financial barriers.

One such barrier is the cost of care of patients who must be monitored for at least two hours after receiving each dose of ketamine — whether an injection with generic ketamine or nasal spray with Spravato — and as ongoing doses are needed for the treatment to be effective, the mounting costs can become prohibitive for many.

While it is now more than 20 years since the first indications that generic ketamine was effective, public funding to support research and patient access has been slow, uncoordinated and underfunded, the researchers said. In addition, there have been insufficient commercial incentives to conduct the research and development of generic ketamine, nor any schemes promoting public–private partnerships.

“Our findings accentuate an urgent need for structural reforms,” said Professor Anthony Rodgers from The George Institute, which is affiliated with UNSW Sydney. “It’s imperative that we harness collective efforts to ensure the affordable becomes accessible, ushering in a new era of mental health care that is both effective and economically sustainable.”

Solutions put forward by Rodgers and his colleagues include boosting funding for integrated and translational research; reducing regulatory hurdles; optimising clinical trial procedures; and fostering broader collaboration across sectors and borders.

Co-author Professor Colleen Loo, a clinical psychiatrist with the UNSW-affiliated Black Dog Institute, said she had witnessed remarkable results over the last 12 years using low-cost ketamine to treat severe depression that has not responded to other treatments.

“To make this treatment accessible to patients, Medicare funding of the treatment process is required, but the process is blocked by systemic barriers as explained in this paper,” Loo said.

“As there is no commercial gain for pharmaceutical companies in supporting a listing of low-cost, off-patent ketamine as a treatment for depression, the drug is not listed by the TGA for such use, and thus cannot attract Medicare funding for the treatment,” she continued.

“This is despite all parties recognising that repurposing of existing, low-cost, off-patent drugs for new uses is in society’s interest. We need government to intervene, to shift these barriers.”

The authors and their respective institutions are planning an application to Medicare to have ketamine treatment for severe depression supported by the government health system.

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