Treatment patterns, healthcare utilization, and costs of patients with treatment-resistant depression initiated on Esketamine intranasal spray and covered by US commercial health plans
This analysis of health outcomes (n=269) of those treated with esketamine for treatment-resistant depression (TRD) finds a trend (but not significant differences) towards lower healthcare costs. Dosing intervals (of ketamine) were longer than recommended on the label.
Authors
- Kruti Joshi
- Maryia Zhdanava
- Dominic Pilon
Published
Abstract
Aims
To describe real-world use of esketamine (ESK) intranasal spray and healthcare outcomes among patients with treatment-resistant depression (TRD) in the United States (US).
Methods
Adults with TRD initiated on ESK (index date) between 5 March 2019 (US approval date for TRD) and 31 October 2020 were sampled from IBM MarketScan Research Databases. TRD was defined as claims for ≥2 unique antidepressants during the same major depressive episode. Subgroups of the TRD cohort with comorbid cardiometabolic conditions, pain, anxiety disorder, and substance use disorder (SUD) were identified. Patients had ≥6 months of continuous health plan eligibility pre- and post-index.
Results
The TRD cohort comprised 269 patients; comorbidity subgroups included 123 (cardiometabolic), 144 (pain), 189 (anxiety disorder), and 58 (SUD) patients. Proportion of patients completing ≥8 ESK sessions (number of sessions in induction phase) was 61.3% in the TRD cohort and ranged from 60.2% (cardiometabolic subgroup) to 72.4% (SUD subgroup) in subgroups. Median frequency of induction sessions was every 5-8 days among the TRD cohort and subgroups. Mean mental health-related inpatient costs reduced from pre- to post-index periods in the TRD cohort (mean ± standard deviation [median] costs per-patient-per-6-months: $3,480 ± $13,328 [$0] pre-ESK initiation; $3,262 ± $16,666 [$0] post-ESK initiation; mean difference: -$218) and subgroups (largest decrease in cardiometabolic subgroup: $4,864 ± $14,271 [$0]; $2,792 ± $15,757 [$0]; -$2,072). Mean mental health-related emergency department (ED) costs decreased in the TRD cohort ($608 ± $2,525 [$0]; $269 ± $1,143 [$0]; -$339) and subgroups (largest decrease in the SUD subgroup: $1,403 ± $3,752 [$0]; $351 ± $868 [$0]; -$1,052).
Limitations
This is a descriptive analysis; sample size for some comorbidity subgroups is small.
Conclusions
The majority of patients completed ESK induction phase, and most dosing intervals were longer than the label recommendation. In this descriptive analysis, mental health-related inpatient and ED costs trended lower post-ESK initiation.
Research Summary of 'Treatment patterns, healthcare utilization, and costs of patients with treatment-resistant depression initiated on Esketamine intranasal spray and covered by US commercial health plans'
Introduction
Major depressive disorder (MDD) affects an estimated 8.4% of US adults, and roughly 30% of treated patients with MDD—about 1.1% of the adult population—experience treatment-resistant depression (TRD), typically defined as inadequate response to two or more adequate antidepressant trials. TRD is associated with substantially worse clinical and economic outcomes than non-TRD MDD: lower remission and response after multiple trials, higher rates of comorbid physical and mental conditions (for example cardiometabolic disease and anxiety), greater healthcare use, and notable productivity losses. The authors cite an annual societal burden estimate of $43.8 billion attributable to TRD and report that patients with TRD take on average 35.8 work-loss days per year, translating into higher work-loss rates compared with employees without MDD or without TRD. This study set out to describe real-world use of esketamine (ESK) intranasal spray and associated healthcare resource use and costs among patients with TRD in the United States following ESK approval for TRD in 2019. Specifically, the investigators aimed to characterise treatment patterns (session counts, dosing, timing), and to compare acute-care utilisation and costs in the 6 months before versus the 6 months after ESK initiation, including analyses in subgroups with cardiometabolic conditions, pain, anxiety disorder, and substance use disorder (SUD). The focus was on patients treated at REMS-certified centres and covered by US commercial or Medicare supplemental plans.
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Study Details
- Study Typeindividual
- Journal
- Compounds
- Topics
- Authors
- APA Citation
Joshi, K., Pilon, D., Shah, A., Holiday, C., Karkare, S., & Zhdanava, M. (2023). Treatment patterns, healthcare utilization, and costs of patients with treatment-resistant depression initiated on Esketamine intranasal spray and covered by US commercial health plans. Journal of Medical Economics, 26(1), 422-429. https://doi.org/10.1080/13696998.2023.2188845
Cited By (2)
Papers in Blossom that reference this study
Janik, A., Qiu, X., Lane, R. et al. · JAMA Psychiatry (2025)
Zhdanava, M., Teeple, A., Pilon, D. et al. · Journal of Medical Economics (2023)
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