Cost-per-remitter for esketamine nasal spray versus quetiapine for treatment-resistant depression
Using ESCAPE-TRD trial data in an Excel-based model, esketamine nasal spray plus an oral antidepressant achieved a 50% remission rate at 32 weeks versus 33% for quetiapine XR plus an oral antidepressant. The model estimated lower cost-per-remitter for esketamine (about $3,102 lower in a commercial setting and $456 lower in Medicaid), suggesting esketamine plus an oral antidepressant is cost‑effective for adults with treatment‑resistant depression.
Authors
- Kruti Joshi
Published
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.
Research Summary of 'Cost-per-remitter for esketamine nasal spray versus quetiapine for treatment-resistant depression'
Introduction
Major depressive disorder is common in the United States and imposes substantial clinical, economic and societal burden. A sizeable subset of people with MDD meet criteria for treatment-resistant depression (TRD), commonly defined as failure to respond to at least two adequate antidepressant trials; recent estimates place TRD prevalence at about 30.9% of medication-treated MDD patients. Standard approaches for TRD include further oral antidepressants, augmentation with atypical antipsychotics (for example quetiapine), esketamine and brain stimulation modalities such as electroconvulsive therapy or repetitive transcranial magnetic stimulation (rTMS). Antipsychotic augmentation and brain stimulation each have practical or safety drawbacks—low adherence and metabolic adverse effects for antipsychotics, and clinical and economic burden for some brain stimulation approaches—so there is interest in treatments that combine clinical effectiveness with feasible use for patients and payers. Clemens and colleagues used the ESCAPE-TRD phase IIIb trial, which compared esketamine nasal spray plus an oral antidepressant (ESK NS + OAD) versus quetiapine extended release plus an oral antidepressant (QTP XR + OAD), as the clinical efficacy source for an economic modelling exercise. The present study develops an Excel-based cost model to estimate cost-per-remitter over 32 weeks from US commercial and Medicaid payer perspectives, incorporating direct healthcare costs and indirect productivity losses. The investigators also tested an alternative post-discontinuation care scenario and conducted probabilistic sensitivity analysis to explore parameter uncertainty.
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Study Details
- Study Typemeta
- Journal
- Compounds
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- APA Citation
Clemens, K., Teeple, A., Rive, B., Kirson, N., Desai, U., Doran, J., Eid, D., Qu, A., Bowrey, H., & Joshi, K. (2025). Cost-per-remitter for esketamine nasal spray versus quetiapine for treatment-resistant depression. Journal of Comparative Effectiveness Research. https://doi.org/10.57264/cer-2024-0092
References (5)
Papers cited by this study that are also in Blossom
Voineskos, D., Daskalakis, Z. J., Blumberger, D. M. · Neuropsychiatric Disease And Treatment (2020)
Reif, A., Bitter, I., Buyze, J. et al. · New England Journal of Medicine (2023)
McIntyre, R. S., Mattingly, G., Godinov, Y. et al. · CNS Spectrums (2025)
Jiang, Y., Du, Z., Shen, Y. et al. · European Archives of Psychiatry and Clinical Neuroscience (2023)
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