Adults with treatment-resistant depression who completed induction treatment with esketamine nasal spray showed reductions in acute healthcare costs, particularly among those who had prior mental health-related hospitalizations or emergency visits. In a cohort of 322 patients, mean all-cause acute healthcare costs per patient per month fell from $837 before treatment to $770 after, while mental health-related costs dropped from $648 to $577. Among 111 patients with prior acute care use, all-cause costs decreased from $2,323 to $1,423, driven by mental health-related cost reductions from $1,880 to $1,139. Patients generally took longer than the label-recommended 28 days to complete the eight induction sessions, averaging 73 days. Most patients continued with maintenance sessions.
Among adults with treatment-resistant depression in the United States, those with both less than a bachelor's degree and a household income below $75,000 had a 37% lower chance of starting esketamine nasal spray, a novel therapy. In a commercial or Medicare Advantage cohort of 201,937 patients, females also had a lower chance of initiation (hazard ratio 0.63). A separate Medicaid cohort of 51,206 patients showed a similar trend for females, though not statistically significant. Racial or ethnic minorities had similar chances of starting esketamine as White patients in both groups. The findings point to a health equity gap based on education, income, and gender.