Cost-per-remitter for esketamine nasal spray versus quetiapine for treatment-resistant depression
Bowrey, H. E., Clemens, K., Desai, U., Doran, J., Eid, D., Joshi, K., Kirson, N., Qu, A., Rive, B., Teeple, A.
This economic analysis comparing esketamine nasal spray (plus oral antidepressant) versus quetiapine extended release (plus oral antidepressant) for treatment-resistant depression (TRD) found esketamine achieved higher remission rates at 32 weeks (50% vs 33%) and lower cost-per-remitter in both commercial ($3,102 lower) and Medicaid ($456 lower) settings, with even greater cost savings in scenarios where non-responders received transcranial magnetic stimulation.
Abstract
Aim: Estimate the cost-per-remitter with esketamine nasal spray plus an oral antidepressant (ESK NS + OAD) versus quetiapine extended release plus an oral antidepressant (QTP XR + OAD) among adults with treatment-resistant depression (TRD). Materials $ methods: An Excel-based model was developed to estimate the cost-per-remitter for ESK NS + OAD and QTP XR + OAD from the perspective of a US commercial insurance plan and Medicaid. Remission and response rates were estimated in 4-week intervals over 32 weeks using data from the ESCAPE-TRD phase IIIb clinical trial comparing ESK NS + OAD versus QTP XR + OAD in adults with TRD. Direct healthcare costs were sourced from health economic literature and the RED BOOK® drug pricing database. Indirect costs were derived from a separate analysis of ESCAPE-TRD using the Work Productivity and Activity Impairment: Depression questionnaire. Adults not remitting/responding either stayed on current treatment or discontinued current treatment and initiated either augmented therapy with antipsychotics or repetitive transcranial magnetic stimulation. In a scenario analysis, all individuals who did not achieve response and discontinued treatment initiated repetitive transcranial magnetic stimulation. Results: The remission rate at 32 weeks was 50% for adults receiving ESK NS + OAD and 33% for adults receiving QTP XR + OAD. The cost-per-remitter for ESK NS + OAD compared with QTP XR + OAD was $3102.17 lower in the commercial setting and $456.12 lower in the Medicaid setting. Under the scenario analysis, the cost-per-remitter for ESK NS + OAD compared with QTP XR + OAD was $15,133.66 lower in the commercial setting and $12,487.62 lower in the Medicaid setting. Conclusion: The findings suggest that ESK NS + OAD is a cost-effective treatment for adults with TRD compared with QTP XR + OAD in the commercial and Medicaid settings.