Clinician Crunch: How Group Therapy Unlocks The Potential Of Psychedelic Treatments

This article is based on a paper by Dr. Elliot Marseille et al. He is the director of the Collaborative for the Economics of Psychedelics (CEP) at UC Berkeley. “CEP is a network of health economists dedicated to achieving the potential of psychedelic therapies for high-priority mental health conditions.” Dr. Marseille’s bio can be read here.

Before we dive in, huge gratitude to Dr. Marseille, he was very gracious with his time and he provided great insights about his cost effectiveness work at CEP.

If you’re an avid reader of ours, you know there has been a wave of clinical trials that has revealed promising evidence suggesting that psychedelic therapies could offer groundbreaking solutions for psychiatric disorders that are notoriously challenging to treat. We have discussed several of those previously. The results, coupled with a growing public awareness and advocacy, have sparked a renewed interest and a shift in societal attitudes towards these substances.

But, following FDA approval getting these therapies to everyone who needs them will not be  easy. They can be expensive, hard to access, and not always available to everyone. Additionally, there is a huge shortage of mental health providers and these psychedelic assisted therapies require additional supervision that will make the gap between supply and demand for trained clinicians even larger.

Most treatment options have to be effective in terms of treatment outcomes before regulatory bodies such as FDA would approve them. I used the word, “most”, because this is America and lobbying is a thing, but I digress. Although therapies may be effective, payors may not always want to pay for them, because there might be a cost effective way to get close to the same or similar outcome. Previously, we covered why cost effectiveness plays an important role in healthcare and that article can be read here.

Psychedelic assisted therapy can be perceived as costly from a payor point of view. Enter group therapy—an age-old concept given a new lease on life in the realm of psychedelic treatments. This could make psychedelic therapies cheaper and open up doors for more people to get help. This study is the first to look at the potential benefits of using group therapy in psychedelic treatments and how it could impact costs, therapist availability, and patient access.

This work is really important because not only it validates the hypothesis, but this could also be used to advocate to payors to show objective data when these treatment options are FDA approved. I particularly enjoyed this study, because the researchers are already thinking ahead and thinking about pragmatic ways to implement these new (if you consider centuries old, new) treatments.  Let’s briefly review the study:

 

Method

The CEP team estimated the cost of the following treatment protocols used in two trials:

1. Veterans with PTSD using MDMA therapy (SNaP Lab at the VA)

2. Cancer patients with major depression disorder using psilocybin (Sunstone Therapy)

The researchers compared the costs and time needed for each method. In the first trial, therapists treated six patients at once in some sessions but mainly were treated individually, while in the second trial, each patient had their own therapist entirely. They also estimated the number of therapists needed to help all eligible patients over ten years.They used detailed cost calculations, including therapist wages, medication costs, and other expenses. They explored different scenarios and assumptions to understand how these therapies could be more accessible and affordable for more people.

Above details are selected for simplicity, full details can be found in the original paper.

 

Results

The findings were illuminating to say the least.

Adopting a group therapy approach could potentially treat an additional 28.9 patients (PTSD) and 29.5 patients (major depression disorder) annually per clinician. This translates to a significant reduction in the number of clinicians needed—6,700 fewer for PTSD and 1,159 fewer for major depression disorder over ten years in the US.

Moreover, the cost savings per patient could be around $3,500 and $1,000for PTSD and major depression disorder, respectively.

 

Implication 

Even though the overall cost reduction can be relatively modest because the cost of medication can be a huge factor here, it still proves a concept. It makes these therapies more affordable, which is good news for the folks who decide what treatments insurance will cover. So, there’s a higher chance that more people can get this kind of therapy.

It also cuts down clinician costs by a lot—about half for the first kind of therapy (MDMA/PTSD) and about a third for the other one (psilocybin/MDD). So, what does this mean? Well, it’s like having double the number of therapists to help people with these therapies. It also means we can reach more people in less time.

Group therapy still needs skilled clinicians, and we shouldn’t compromise on quality just to save money as researchers pointed out. So, while group therapy can help, we also need to think about other ways to encourage more people to become mental health professionals and maybe let different kinds of trained staff help out too.

The other big consideration is the effectiveness of group size. The group size needs to be ideal and not too large where people may lose the intended therapeutic benefit of talk therapy and safety of supervision. Certain people may not thrive in a group environment and there are many other reasons that group therapy may not be for everyone.

The important part is that this paper proves that you can provide psychedelic assisted therapy in a cost effective way and it may significantly reduce the provider burden. Psychedelic assisted group therapy has a potential to alleviate sufferings in an economical way in this resource finite world.

 

Referenced Study:

https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1293243/full