Cost, cost-effectiveness, and budget impact analysis
Here you can explore our current active projects and publications within cost, cost-effectiveness, and budget impact analysis.
Current Projects
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ORCHID
Oregon–Colorado Regulated Psychedelic Care: Healthcare Impacts & Decisions
Oregon and Colorado are the first states to license psilocybin services outside of a clinical trial, which makes them the first places where the health system effects of regulated psychedelic care can be observed rather than modeled. ORCHID generates real-world evidence on what happens after people receive services through these programs: how their healthcare costs change, how their use of other services changes, and how their outcomes compare. Cost-effectiveness models built on trial data have to assume these effects. ORCHID measures them, which is what insurers, employers, and policymakers need before coverage decisions become possible. Currently raising funds to launch.
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Cost-effectiveness of ibogaine for opioid withdrawal
Ibogaine is used for opioid withdrawal largely outside the US medical system, and interest in bringing it inside is moving faster than the economic evidence. With Jim Kahn, CEP is building a cost-effectiveness analysis comparing ibogaine-assisted therapy with medication-assisted treatment, from a Medicaid perspective. The Medicaid framing is deliberate: Medicaid pays for a large share of opioid use disorder treatment in the United States, so its budget is where any coverage decision about ibogaine would land. The analysis plan is complete and the model is in design.
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Ketamine IVPE
Ketamine is already in wide off-label use for depression, paid for mostly out of pocket and delivered outside the pathway a new drug normally travels. That makes it a test case for whether rigorous economic evidence can be generated for a treatment no manufacturer has an incentive to study. Alongside Public Good Pharma, CEP plans to conduct the economic analysis for an IVPE trial of ketamine therapy for major depressive disorder.
Publications
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Cost-Effectiveness of Psilocybin Treatment Compared with Nicotine Replacement Therapy for Tobacco Cessation in Treatment-Resistant Cigarette Smokers
Wang Y, Johnson M, Marseille E. Cost-Effectiveness of Psilocybin Treatment Compared with Nicotine Replacement Therapy for Tobacco Cessation in Treatment-Resistant Cigarette Smokers. Nicotine and Tobacco Research. Under review, 2026.
Compares psilocybin-assisted treatment with nicotine replacement therapy for smokers who have not succeeded with standard cessation aids, a group for whom conventional options have largely run out.
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Inappropriate Comparator and High Pricing in MDMA-Assisted Therapy for PTSD
Marseille E, Mitchell JM. Inappropriate Comparator and High Pricing in MDMA-Assisted Therapy for PTSD: A Critique of the Lykos Cost-Effectiveness Analysis. Psychedelics. 2025.
Argues that the published cost-effectiveness analysis of Lykos Therapeutics’ MDMA-assisted therapy rested on an inappropriate comparator and an unjustifiably high assumed price. Both choices flatter the treatment’s apparent value, and correcting them changes what payers should be willing to pay for it.
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The cost-effectiveness of psilocybin-assisted therapy for treatment-resistant depression in the US
Avancena A, Vuong L, Kahn JG, Marseille E. The cost-effectiveness of psilocybin-assisted therapy for treatment-resistant depression in the US. Translational Psychiatry. 2025 (in press).
Models the lifetime costs and health outcomes of psilocybin-assisted therapy for treatment-resistant depression in the United States, compared against the standard care those patients receive now.
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Group psychedelic therapy: empirical estimates of cost-savings and improved access
Marseille E, Stauffer CS, Agrawal M, et al. Group psychedelic therapy: empirical estimates of cost-savings and improved access. Frontiers in Psychiatry. 2023;14:1293243.
Estimates what changes when psychedelic therapy is delivered to groups rather than one patient at a time. Group delivery lowers cost per patient substantially and cuts the number of trained clinicians needed to serve a given population, which is the binding constraint on scaling these therapies.
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Updated cost-effectiveness of MDMA-assisted therapy for the treatment of posttraumatic stress disorder in the United States
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(2):e0263252. doi:10.1371/journal.pone.0263252
Updates CEP’s earlier economic model of MDMA-assisted therapy for chronic PTSD using phase 3 trial results in place of phase 2 estimates. The therapy remains highly favorable economically once the stronger efficacy data are used.
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The costs and health benefits of expanded access to MDMA-assisted therapy for chronic and severe PTSD in the USA
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. Clinical Drug Investigation. 2022. doi:10.1007/s40261-022-01122-0
Models what would happen to national costs and population health if MDMA-assisted therapy were made broadly available to Americans with chronic and severe PTSD, rather than to trial participants alone.
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The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD
Marseille E, Kahn JG, Yazar-Klosinski B, Doblin R. The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD. PLoS One. 2020;15(10):e0239997. doi:10.1371/journal.pone.0239997
CEP’s first cost-effectiveness analysis of MDMA-assisted psychotherapy, and the study that put the economic case for the therapy into the peer-reviewed literature. It found the treatment cost-saving relative to standard care over the modeled horizon.