Among US adults with treatment-resistant depression who initiated esketamine nasal spray, those whose health plans had prior authorization criteria stricter than the drug label (stringent cohort, 168 patients) and those with less or equally strict criteria (non-stringent cohort, 400 patients) had similar treatment histories. Both groups completed about four antidepressant treatment courses on average before starting esketamine, and roughly 95% used augmentation therapy, with about 59% using an antipsychotic. These averages exceeded the number of antidepressant trials mandated by the esketamine label, suggesting that requiring additional prior authorization steps beyond the label may not be necessary.
Among US adults with treatment-resistant depression, those who started esketamine nasal spray had fewer mental-health-related disability days and lower associated costs six months later compared with the month before starting treatment. In the esketamine group, disability days fell by an average of 0.4 days and costs dropped by $312 per patient per month. Trends for other therapies varied: transcranial magnetic stimulation showed a $123 cost reduction with no change in disability days, second-generation antipsychotic augmentation showed little change, and electroconvulsive therapy was linked to increases in both disability days and costs. The findings suggest esketamine may reduce disability burden, but the study was descriptive and lacked statistical comparisons.