What MDMA-Assisted Therapy Could Do for PTSD and Cost of Healthcare

While methylenedioxymethamphetamine (MDMA) is still illegal in the United States, the body of research supporting its potential to treat post-traumatic stress disorder (PTSD) is growing.

Building on a 2021 Phase 3 trial, considered the final step in clinical drug testing before approval, which found MDMA-assisted therapy to be significantly safe and effective in treating severe, chronic PTSD, new research suggests that not only can MDMA-assisted psychotherapy improve and extend the lives of PTSD patients, it can also reduce healthcare costs.

The Research

Using data from MDMA-assisted therapy's Phase 3 trial, researchers calculated mortality, expected medical costs and incremental cost-effectiveness ratio for the treatment over 30 years. The findings, published in PLOS ONE, estimate that this choice in treatment for a cohort of 1000 hypothetical patients would prevent about 61 premature deaths while saving $132.9 million over the course of 30 years.

The background of study author Elliot Marseille, DrPH, MPP is in the economic evaluation of global health interventions; for example, the prevention and treatment of HIV/AIDS. Through a connection to the Multidisciplinary Association for Psychedelic Studies (MAPS), he offered his economic expertise to aid in the approval process of MDMA therapy in Europe, then launched the Global Initiative for Psychedelic Science Economics (GIPSE) in an effort to provide rigorous economic analysis of these emerging therapies.

"I have long suspected that psychedelics, when used thoughtfully and in a safe environment, could have beneficial effects..." Marseille says. "I saw this as an opportunity to contribute to the effort to accelerate access to what already looked like a promising new therapy."

Although studies to determine the long-term effects of MDMA-assisted therapy on PTSD are still currently in the works, those effects are still unknown. But for now, this type of treatment isn't intended for long-term, ongoing use. The Phase 3 trial consisted of three sessions, whereas the Phase 2 trial consisted of two sessions. Researchers suggest the three-session regimen can provide incremental benefit.

"This is incredibly encouraging and can provide data to justify insurance companies' willingness to cover these powerful and life-changing treatments," says Steven Radowitz, MD, medical director of psychedelic wellness clinics network Nushama.

The Cost of Care

The sticker price of MDMA treatments may seem high, notes Scott Fisher, MD psychiatric lead for psychedelic venture firm Iter Investments, especially when considering the cost of the drug itself. But a lot of unseen preparation and expertise go into a session. According to Fisher, reaching the max benefit of a single session requires two highly trained therapists and 20-40 hours of preparation, dosing and integration sessions.

Without this framework, he says, the drug experience could be wasted or even harmful to patients.

"The cost-effectiveness of this treatment might not seem obvious to most, but our data shows the severe burden PTSD carries not only on the lives of those who suffer from the disorder but also in terms of cost for our healthcare system," Fisher says.

Because MDMA-assisted therapy is psychotherapy-intensive, it can be costly upfront. This is why the researchers of this study are focused on translating its cost-effectiveness to third-party payers.

"While a few affluent people will be able to pay from their own pockets, if this therapy is going to be accessible to enough people to make a public health impact, it needs to be funded by third party payers such as private health insurance companies or public payers such as the Veterans Administration," Marseille says. "From the point of view of such payers it matters whether the initial high cost can be defrayed via savings in medical expenditures."

He points out that lessening the severity of an individual's PTSD will not only lower psychiatric care costs, but general medical care costs, as well.

"We estimate that for 1000 patients, savings would approximate $133 million over 30 years," Marseille says.

And going forward, researchers hope to tackle ways of further decreasing the cost of treatment regimens without sacrificing their effectiveness.

"For example, are two highly trained therapists really required for all sessions?" Marseille says. "Could at least some of the sessions be done in groups? Developing alternatives to the one client, two therapist model could be a way to reduce costs and increase access."

Overall, psychedelic research is on the rise as individuals and mental health professionals seek out solutions to root problems, rather than just treatment to suppress symptoms. If MDMA-assisted therapy continues down the road to FDA approval, it will be another step toward prioritizing holistic mental health.

"This will be a massive shift in the way we approach mental health issues,” Radowitz says. “We have tools now to try to get to the seed level of people's inner struggles. This treatment allows for a deep acceptance, positive processing, and reframing of challenging situations that are the source of most mental health conditions.”