Esketamine nasal spray for major depressive disorder with acute suicidal ideation or behavior: description of treatment access, utilization, and claims-based outcomes in the United States
This real-world (n=269) analysis of esketamine (Spravato) use finds nearly 50% of patients had their first pharmacy claim approved. Of those approved, 45% had eight or more treatment sessions (as recommended), though spread over 85 days (versus 28 per the label). Patients had lower health utilization, but this could be due to factors outside of the esketamine treatment (e.g. regression to the mean).
Authors
- Kruti Joshi
- Maryia Zhdanava
- Dominic Pilon
Published
Abstract
Aims
To describe real-world esketamine nasal spray access and use as well as healthcare resource use (HRU) and costs among adults with evidence of major depressive disorder (MDD) with suicidal ideation or behavior (MDSI).
Methods
Adults with ≥1 claim for esketamine nasal spray and evidence of MDSI 12 months before/on the date of esketamine initiation (index date) were selected from Clarivate’s Real World Data product (01/2016-03/2021). Patients initiated esketamine on/after 03/05/2019 (esketamine approval for treatment-resistant depression; later approved for MDSI on 08/05/2020) were included in the overall cohort. Esketamine access (measured as approved/abandoned/rejected claims) and use were described post-index; HRU and healthcare costs (2021 USD) were described over 6 months pre- and post-index.
Results
Among 269 patients in the overall cohort with esketamine pharmacy claims, 46.8% had the first pharmacy claim approved, 38.7% had it rejected, and 14.5% abandoned their claim; 169 patients were initiated on esketamine in the overall cohort (mean age 40.9 years, 62.1% female); 45.0% had ≥8 esketamine treatment sessions (recommended per label) with a mean [median] of 85.0 [58.5] days from index to 8th session (per label 28 days). Among 115 patients with ≥6 months of data post-index, in the 6-month pre- and post-index, respectively, 37.4% and 19.1% had all-cause inpatient admissions, 42.6% and 33.9% had emergency department visits, 92.2% and 81.7% had outpatient visits; mean ± standard deviation all-cause monthly total healthcare costs were $8,371±$15,792 and $6,486±$7,614, respectively.
Limitations
This was a descriptive claims-based analysis; no formal statistical comparisons were performed due to limited sample size as data covered up to 24 months of esketamine use in the US clinical setting.
Conclusions
Nearly half of patients experience access issues with first esketamine nasal spray treatment session. All-cause HRU and healthcare costs trend lower in the 6 months after relative to 6 months before esketamine initiation.
Research Summary of 'Esketamine nasal spray for major depressive disorder with acute suicidal ideation or behavior: description of treatment access, utilization, and claims-based outcomes in the United States'
Introduction
Major depressive disorder (MDD) affects a substantial proportion of US adults and can include suicidal ideation or behaviour (MDSI), a condition that is often underdiagnosed and may have risen during the COVID-19 pandemic. Previous work has documented the high clinical and economic burden associated with MDSI, including costly hospital care after suicide-related events, and highlighted gaps in prior treatment before such events. Esketamine nasal spray received US Food and Drug Administration approval for treatment-resistant depression (TRD) on 03/05/2019 and for MDSI on 08/05/2020; clinical trials showed rapid reductions in depressive symptoms when esketamine was combined with an oral antidepressant, but real-world evidence on access, utilisation, and outcomes in MDSI is limited. Zhdanava and colleagues set out to describe real-world access to and use of esketamine nasal spray among adults with evidence of MDSI, and to characterise healthcare resource use (HRU) and costs before and after treatment initiation. The study used an open claims database that allows inspection of pharmacy claim lifecycles (approved, rejected, abandoned), enabling an analysis of administrative barriers to treatment as well as patterns of dosing, session frequency, clinical severity, HRU, and costs in routine US practice shortly after esketamine's regulatory approvals.
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Study Details
- Study Typeindividual
- Journal
- Compounds
- Topics
- Authors
- APA Citation
Zhdanava, M., Teeple, A., Pilon, D., Shah, A., Caron-Lapointe, G., & Joshi, K. (2023). Esketamine nasal spray for major depressive disorder with acute suicidal ideation or behavior: description of treatment access, utilization, and claims-based outcomes in the United States. Journal of Medical Economics, 26(1), 691-700. https://doi.org/10.1080/13696998.2023.2208993
References (4)
Papers cited by this study that are also in Blossom
Canuso, C. M., Ionescu, D. F., Li, X. et al. · Journal of Clinical Psychopharmacology (2021)
Joshi, K., Pilon, D., Shah, A. et al. · Journal of Medical Economics (2023)
Ionescu, D. F., Lane, R., Lim, P. et al. · Journal of Clinical Psychiatry (2020)
Ionescu, D. F., Qiu, X., Lane, R. et al. · International Journal of Neuropsychopharmacology (2020)
Cited By (2)
Papers in Blossom that reference this study
Samalin, L., Rothärmel, M., Mekaoui, L. et al. · Journal of Psychiatric Research (2026)
Harding, L., Zhdanava, M., Teeple, A. et al. · Clinical Therapeutics (2025)
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