Group Psychedelic Therapy: Empirical Estimates of Cost-Savings and Improved Access

Authors

Elliot Marseille, Christopher S. Stauffer, Manish Agrawal, Paul Thambi, Kimberly Roddy,  Michael Mithoefer, Stefano M. Bertozzi, and James G. Kahn

Originally published in Frontiers in Psychiatry as Group psychedelic therapy: empirical estimates of cost-savings and improved access.

Published Date: December 6, 2023

 

Abstract

Objective

To compare group and individual psychedelic-assisted therapy in terms of clinician time, costs and patient access.

Methods

Using 2023 data from two group therapy trial sites, one using 3,4-Methylenedioxymethamphetamine (MDMA) to treat posttraumatic stress disorder (PTSD), and one using psilocybin to treat major depressive disorder (MDD), we compared overall variable costs, clinician costs and clinician time required by therapy protocols utilizing groups versus individual patient therapy. Using published literature, we estimated the prevalence of adults with PTSD and MDD eligible for treatment with psychedelic therapy and projected the savings in time and cost required to treat these prevalent cases.

Results

Group therapy saved 50.9% of clinician costs for MDMA-PTSD and 34.7% for psilocybin-MDD, or $3,467 and $981 per patient, respectively. To treat all eligible PTSD and MDD patients in the U.S. in 10 years with group therapy, 6,711 fewer full-time equivalent (FTE) clinicians for MDMA-PTSD and 1,159 fewer for FTE clinicians for psilocybin-MDD would be needed, saving up to $10.3 billion and $2.0 billion respectively, discounted at 3% annually.

Conclusions

Adopting group therapy protocols where feasible would significantly reduce the cost of psychedelic-assisted therapies. By enhancing the number of patients served per clinician, group therapy could also ameliorate the anticipated shortage of appropriately trained clinicians, thereby accelerating access to these promising new therapies.

References

1. Mitchell JM, Bogenschutz M, Lilienstein A, Harrison C, Kleiman S, Parker-Guilbert K, et al.. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. (2021) 27:1025–33. doi: 10.1038/s41591-021-01336-3, PMID.

2. Mithoefer MC, Mithoefer AT, Feduccia AA, Jerome L, Wagner M, Wymer J, et al.. 3, 4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. Lancet Psychiatry. (2018) 5:486–97. doi: 10.1016/s2215-0366(18)30135-4.

3. Jerome L, Feduccia AA, Wang JB, Hamilton S, Yazar-Klosinski B, Emerson A, et al.. Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials. Psychopharmacology. (2020) 237:2485–97. doi: 10.1007/s00213-020-05548-2.

4. Bogenschutz MP, Ross S, Bhatt S, Baron T, Forcehimes AA, Laska E, et al.. Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry. (2022) 79:953–62. doi: 10.1001/jamapsychiatry.2022.2096.

5. Johnson MW, Garcia-Romeu A, Griffiths RR. Long-term follow-up of psilocybin-facilitated smoking cessation. Am J Drug Alcohol Abuse. (2017) 43:55–60. doi: 10.3109/00952990.2016.1170135.

6. Carhart-Harris R, Giribaldi B, Watts R, Baker-Jones M, Murphy-Beiner A, Murphy R, et al.. Trial of psilocybin versus escitalopram for depression. N Engl J Med. (2021) 384:1402–11. doi: 10.1056/NEJMoa2032994.

7. Davis AK, Barrett FS, May DG, Cosimano MP, Sepeda ND, Johnson MW, et al.. Effects of psilocybin-assisted therapy on major depressive disorder: a randomized clinical trial. JAMA Psychiatry. (2020) 78:481–9. doi: 10.1001/jamapsychiatry.2020.3285.

8. Ross S, Bossis A, Guss J, Agin-Liebes G, Malone T, Cohen B, et al.. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. (2016) 30:1165–80. doi: 10.1177/0269881116675512.

9. Agrawal M, Emanuel E, Richards B, Richards W, Roddy K, Thambi P. Assessment of psilocybin therapy for patients with Cancer and major depression disorder. JAMA Oncol. (2023) 9:864–6. doi: 10.1001/jamaoncol.2023.0351.

10. Davis J., Lampert J., Rockingstone Group . Expediting psychedelic-assisted therapy adoption in clinical settings. (2022). Available at: https://www.brainfutures.org/mental-health-treatment/expeditingpatadoption/

11. Jamison Pierce. How “far out” are psychedelic therapeutics? ARK. (2023). Available at: https://ark-invest.com/articles/analyst-research/psychedelic-therapeutics/ (Accessed April 2, 2023).

12. Multidisciplinary Association for Psychedelic Studies . FDA Grants breakthrough therapy designation for MDMA-assisted therapy for PTSD, agrees on special protocol assessment for phase 3 trials. (2017). Available at: https://maps.org/news/media/press-release-fda-grants-breakthrough-therapy-designation-for-mdma-assisted-psychotherapy-for-ptsd-agrees-on-special-protocol-assessment-for-phase-3-trials/

13. Saplakoglu Y. FDA calls psychedelic psilocybin a ‘Breakthrough Therapy’ for severe depression. Live science. (2023). Available at: https://www.livescience.com/psilocybin-depression-breakthrough-therapy.html

14. Multidisciplinary Association for Psychedelic Studies . PRESS RELEASE: FDA agrees to expanded access program for MDMA-assisted therapy for PTSD. Publisher is the Mltidisciplinary Association for Psychedelic Studies. (2020) Available at: https://maps.org/news/media/press-release-fda-agrees-to-expanded-access-program-for-mdma-assisted-psychotherapy-for-ptsd/

15. Siegel JS, Daily JE, Perry DA, Nicol GE. Psychedelic drug legislative reform and legalization in the US. JAMA Psychiatry. (2023) 80:77–83. doi: 10.1001/jamapsychiatry.2022.4101.

16. Penn A, Dorsen CG, Hope S, Rosa WE. Psychedelic-assisted therapy: emerging treatments in mental health disorders. Am J Nurs. (2021) 121:34–40. doi: 10.1097/01.NAJ.0000753464.35523.29

17. Burlingame GM, Kenzie KM, Strauss B. Small group treatment: evidence for effectiveness and mechanisms of change In: Lambert MJ, editor. Bergin & Garfield’s handbook of psychotherapy and behavior change. Hoboken, NJ: Wiley; (2004). 49. 

18. Yalom ID, Leszcz M. The theory and practice of group psychotherapy. New York: Basic books; (2020). 

19. Trope A, Anderson BT, Hooker AR, Glick G, Stauffer C, Woolley JD. Psychedelic-assisted group therapy: a systematic review. J Psychoactive Drugs. (2019) 51:174–88. doi: 10.1080/02791072.2019.1593559.

20. Oehen P, Gasser P. Using a MDMA- and LSD-group therapy model in clinical practice in Switzerland and highlighting the treatment of trauma-related disorders. Front Psych. (2022) 13:863552. doi: 10.3389/fpsyt.2022.863552.

21. Grof S. LSD psychotherapy. 2nd ed. Alameda, CA: Multidisciplinary Association for Psychedelic Studies; (1994). 

22. Grof S, Grof C. Holotropic breathwork: a new approach to self-exploration and therapy (Suny series in transpersonal and humanistic psychology). 2nd ed. Albany, New York: State University of New York Press; (2023). 

23. Anderson BT, Danforth A, Daroff PR, Stauffer C, Ekman E, Agin-Liebes G, et al.. Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study. EClinicalMedicine. (2020) 27:100538. doi: 10.1016/j.eclinm.2020.100538.

24. Drummond M. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford Medical Publications, Oxford University Press; (2005). 379 p. 

25. Avancena ALV, Kahn JG, Marseille E. The costs and health benefits of expanded access to MDMA-assisted therapy for chronic and severe PTSD in the USA: a modeling study. Clin Drug Investig. (2022) 42:243–52. doi: 10.1007/s40261-022-01122-0.

26. Substance Abuse and Mental Health Services Administration . Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on drug use and health. (2021). Available at: https://www.samhsa.gov/data

27. National Institute of Mental Health . Major depression. (2023). Available at: https://www.nimh.nih.gov/health/statistics/major-depression (Accessed March 30, 2023)

28. Gaynes BN, Rush AJ, Trivedi MH, Wisniewski SR, Spencer D, Fava M. The STAR*D study: treating depression in the real world. Cleve Clin J Med. (2008) 75:57–66. doi: 10.3949/ccjm.75.1.57.

29. American Psychological Association . Worsening mental health crisis pressures psychologist workforce: 2021 COVID-19 practitioner survey updated October 19, 2021. Available at: https://www.apa.org/pubs/reports/practitioner/covid-19-2021

30. National Council for Mental Wellbeing . New study: behavioral health workforce shortage will negatively impact society. (2023). Available at: https://www.thenationalcouncil.org/news/help-wanted/ (Accessed May 22, 2023)

31. Glastra J. A perspective on providers: scaling PAT in a time of therapist shortages. Psychedelic Alpha. Available at: https://psychedelicalpha.com/news/a-perspective-on-providers-scaling-pat-in-a-time-of-therapist-shortages

32. Penn A. Where have all the therapists gone? Psychology today. NYC, NY: Sussex Pubisher; (2021).

33. Marseille E, Mitchell JM, Kahn JG. Updated cost-effectiveness of MDMA-assisted therapy for the treatment of posttraumatic stress disorder in the United States: findings from a phase 3 trial. PLoS One. (2022) 17:e0263252. doi: 10.1371/journal.pone.0263252.