Esketamine Nasal Spray vs Quetiapine Extended-Release: Examining Work Productivity Loss and Related Costs in Patients With Treatment-Resistant Depression
This secondary analysis (n=321) of the ESCAPE-TRD trial compared work productivity loss (WPL) and related costs in patients with treatment-resistant depression (TRD) receiving esketamine nasal spray (56mg or 84mg) versus quetiapine (atypical antipsychotic) extended release, both combined with an oral antidepressant. By week 8, WPL decreased by 30.3% with esketamine and 17.3% with quetiapine, leading to a cost savings difference of $156 per week. By week 32, WPL reductions were 45.3% (esketamine) and 32.5% (quetiapine), with a weekly cost savings difference of $153.
Authors
- Kruti Joshi
- Maryia Zhdanava
- Dominic Pilon
Published
Abstract
Objective
This post hoc analysis of the ESCAPE-TRD trial compared work productivity loss (WPL) and related costs among patients with treatment-resistant depression (TRD) receiving esketamine nasal spray or quetiapine extended release in combination with an oral antidepressant.
Methods
Adults with TRD randomized to receive esketamine (56/84 mg) or quetiapine (150-300 mg) combined with ongoing antidepressant therapy were included. WPL was assessed using the Work Productivity and Activity Impairment questionnaire. Least squares (LS) mean WPL change versus baseline (treatment initiation date), and LS mean differences (MDs) between esketamine and quetiapine cohorts were reported at weeks 8-32 of treatment using mixed models for repeated measurements. Per patient productivity cost savings were estimated using mean 2021 weekly wages from US Bureau of Labor Statistics.
Results
The esketamine cohort included 165 patients, and quetiapine cohort included 156 patients. At baseline, total WPL was 77.0% and 72.5% in the esketamine and quetiapine cohorts, respectively. By week 8, total WPL decreased from baseline by 30.3 and 17.3 percentage points (pp) in the esketamine and quetiapine cohorts (MD = 13.0 pp; 95% confidence interval [CI], 6.3-19.8 pp), resulting in weekly cost savings of $363 and $207 (MD = $156; 95% CI, $76-$237), respectively. By week 32, total WPL decreased from baseline by 45.3 pp and 32.5 pp in the esketamine and quetiapine cohorts (MD = 12.7 pp; 95% CI, 4.7-20.7 pp), with weekly cost savings of $543 and $390 (MD = $153; 95% CI, $57-$250), respectively.
Conclusion
Among employed adults with TRD, esketamine treatment was associated with significantly larger improvements in WPL and related costs compared to quetiapine, suggesting greater benefits from patient well-being and employer perspectives.
Research Summary of 'Esketamine Nasal Spray vs Quetiapine Extended-Release: Examining Work Productivity Loss and Related Costs in Patients With Treatment-Resistant Depression'
Introduction
Major depressive disorder (MDD) is a common chronic illness in the United States that disproportionately affects adults of working age, and around a third of treated patients develop treatment-resistant depression (TRD), typically defined as failure to respond to at least two adequate antidepressant courses. Clemens and colleagues note that TRD drives substantial unemployment and work productivity loss (WPL), with prior estimates attributing over 60% of the pharmacologically treated MDD productivity burden to TRD. Esketamine, an intranasal, rapidly acting S‑enantiomer of ketamine approved for TRD in 2019, offers a different treatment profile from oral antidepressants and has shown superior clinical response and remission in prior trials when added to an antidepressant compared with standard augmentation strategies such as second‑generation antipsychotics (SGAs). However, the societal benefits of esketamine, specifically its impact on work productivity and related employer costs, have not been fully characterised. This post hoc analysis of the ESCAPE-TRD trial aimed to compare patient‑reported WPL and estimated productivity costs among employed adults with TRD who received either esketamine nasal spray or extended‑release quetiapine, each combined with an oral antidepressant dosed per US labelling. The investigators evaluated changes in absenteeism, presenteeism, and total WPL over a 32‑week period and translated those changes into weekly and annual cost savings using 2021 US labour market data, with sensitivity analyses to reflect wage differences by sex and employment status.
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Study Details
- Study Typeindividual
- Journal
- Compounds
- Topics
- Authors
- APA Citation
Clemens, K., Teeple, A., Zhdanava, M., Shah, A., Joshi, K., Buyze, J., Pilon, D., Bowrey, H. E., & Godinov, Y. (2025). Esketamine Nasal Spray vs Quetiapine Extended-Release: Examining Work Productivity Loss and Related Costs in Patients With Treatment-Resistant Depression. The Journal of Clinical Psychiatry, 86(1). https://doi.org/10.4088/jcp.24m15425
References (1)
Papers cited by this study that are also in Blossom
Teeple, A., Zhdanava, M., Pilon, D. et al. · Current Medical Research and Opinion (2023)
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