Low-cost ketamine therapy inaccessible for many
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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