The drug, ketamine has emerged as an option to treat severe depression when other treatments don't work. But for many patients, the drug is prohibitively expensive, costing hundreds of dollars a dose.
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00:00 It really is a breakthrough treatment in efficacy and what we found with a recent big trial
00:06 in Australia was that even in the most severe, the unwell patients, about one in five, will
00:12 get remission of their symptoms and so they'll no longer have significant depression after
00:16 treatment.
00:17 And has that, the evidence of its effectiveness, grown over the past couple of decades?
00:23 Yes, although we'd say not quickly enough.
00:26 We think the funding should have been done earlier on generic ketamine but just in the
00:30 last five years or so it's really picked up that evidence and it's now clear and it's
00:34 recommended by the College of Psychiatrists, for example.
00:38 And so has the world been relatively slow to adopt ketamine as a treatment when you
00:45 compare what's happened with other drugs?
00:48 It has been and we've got this wicked problem where it's a very low cost drug that's been
00:53 known for decades and quite fortuitously it was found out that this anaesthetic might
00:59 actually help depression but because it's a very low cost drug there wasn't much incentive
01:04 for the companies and so it took a lot of time for the public funding agencies like
01:08 NHMRC to fund these trials to completion.
01:12 And so is that changing now?
01:15 Does it appear that the world is slowly embracing ketamine?
01:20 Slowly but we'd say it should be quicker in terms of the speed at which evidence is
01:25 generated for low cost drugs like this.
01:28 And so in which countries has it proceeded most and where does Australia stand in using
01:35 it?
01:36 So Australia's leading in the world globally in conducting the research.
01:41 My colleague Professor Colleen Liu at Black Dog has led the largest trial globally that
01:47 was completed recently and we at the George Institute helped with that.
01:52 It's used and recommended in many countries as well.
01:57 It's widely used in the UK and the US for example and it's recommended by all the major
02:02 colleges of psychiatry.
02:04 But as far as you're concerned it should be more, a regulation should be eased and it
02:09 should be more widely used in Australia?
02:11 So the colleges of psychiatry recommend it but it's the access, it's the costs that
02:17 are the barrier at the moment for patients.
02:21 Each treatment costs several hundred dollars because you need a psychiatrist, a nurse for
02:25 several hours, the clinic time and unfortunately the benefits don't last long for many patients
02:31 so there's repeat treatments that are needed and so the cost becomes prohibitive unless
02:36 there's government funding for those patients.
02:39 So what's the key to getting those costs down?
02:42 So that's where this sort of system problem arises.
02:45 The government committee that have provided the funds for such procedures like this have
02:50 said they'd be happy to receive an application but first they need the TGA, the main regulatory
02:57 body to approve it and even though the colleges of psychiatry recommend it they have a kind
03:03 of one size fits all so they largely have to treat it as if it's a new drug and that's
03:11 a very laborious, time consuming, expensive process and because the drug's so cheap there's
03:17 not much incentive for drug companies at all to do it because there's so many manufacturers
03:22 and it's so cheap.
03:24 So it's a real system problem that we think the government should get behind changing.
03:28 And so how could that be done?
03:31 Well the TGA have put out a very good consultation on ways to make that easier for the barriers
03:38 to go down for the regulator approval.
03:40 They recognise this and I think the other piece of the puzzle has got to be government
03:44 funding to make it worthwhile for companies or to fund public-private partnerships because
03:50 I'm sure they'd much rather fund the better treatments rather than the hospital admissions
03:55 for people with depression for example.
03:57 And are we talking hundreds of millions of dollars that would be need or billions?
04:01 No, no and that's the other great tragedy in this area.
04:05 New chemical, new drugs might cost that much but these kind of development programs are
04:11 relatively low cost.
04:12 They're only a few million, maybe ten million.
04:15 So they're many times less than new drugs.
04:18 And so that's all the government would have to pump into this to open this up to many
04:22 more people?
04:23 That's right.
04:24 If we had funded that ten, fifteen years ago then we would have been in a very different
04:28 position.
04:29 And is there resistance to that still now or not?
04:33 There's not resistance.
04:34 I think it's just the recognition that something needs to be done and it is a lot of money.
04:40 It's a lot more than normal research grants and so it just needs more pump priming for
04:45 the system.
04:46 But there are agencies like Medical Research Future Fund that recognise this.
04:50 They just don't have enough funding in them yet to do it.
04:54 And are you part of the lobbying effort to get this underway?
04:57 Yeah, we've had great reception from the people at the Department of Health and others who
05:03 recognise this problem.
05:04 So we really hope to be part of the solution there.
05:06 there.
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