Journal of managed care & specialty pharmacy
January 1, 2025
Kristin Clemens, Maryia Zhdanava, Amanda Teeple et al.
4 citations
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.
Clinical therapeutics
March 1, 2025
Lisa Harding, Maryia Zhdanava, Amanda Teeple et al.
3 citations
Patients with major depressive disorder accompanied by acute suicidal ideation or behavior who were started on esketamine nasal spray had fewer acute care hospital days and lower medical costs per month than those receiving electroconvulsive therapy or an antidepressant augmented with a second-generation antipsychotic. Among 122 esketamine users, mean acute care use was 0.59 days per month, a 58% decrease from before treatment, compared with 3.17 days (44% increase) for 336 ECT patients and 0.92 days (21% decrease) for 9,958 patients on augmentation therapy. Medical costs per patient per month were $1,869 for esketamine, $4,624 for ECT, and $2,163 for augmentation. The findings suggest esketamine may be associated with lower resource use and cost reductions relative to other treatments.
The Journal of clinical psychiatry
January 27, 2025
Kristin Clemens, Amanda Teeple, Maryia Zhdanava et al.
2 citations
Among employed adults with treatment-resistant depression, esketamine nasal spray plus an oral antidepressant led to larger reductions in work productivity loss and related costs than quetiapine extended release plus an oral antidepressant. By week 8, total work productivity loss decreased by 30.3 percentage points with esketamine versus 17.3 with quetiapine, a difference of 13.0 percentage points. Weekly cost savings were $363 for esketamine and $207 for quetiapine. By week 32, reductions were 45.3 and 32.5 percentage points, respectively, with weekly cost savings of $543 versus $390. The results suggest greater benefits for both patient well-being and employer perspectives.
Journal of comparative effectiveness research
June 9, 2025
Kristin Clemens, Amanda Teeple, Benoit Rive et al.
Esketamine nasal spray plus an oral antidepressant costs less per patient who achieves remission than quetiapine extended release plus an oral antidepressant for adults with treatment-resistant depression. Over 32 weeks, 50% of those taking esketamine plus an antidepressant achieved remission, compared with 33% taking quetiapine plus an antidepressant. The cost-per-remitter was $3,102 lower for esketamine in a commercial insurance setting and $456 lower in a Medicaid setting. In a scenario where non-responders switched to repetitive transcranial magnetic stimulation, the cost savings were larger: $15,134 lower commercially and $12,488 lower for Medicaid. The authors suggest esketamine plus an antidepressant is a cost-effective option.
Current medical research and opinion
February 1, 2025
Manish Jha, Amanda Teeple, Jason Shepherd et al.
Among 914 patients with treatment-resistant depression (TRD) or major depression with suicidal ideation (MDSI), moderate-to-very severe depression affected 36.5% of those with TRD and 48.3% of those with MDSI. Mean work impairment was 26% and overall impairment 34.7%. Most patients reported no-to-mild impairment in basic needs, social functioning, work, quality of life, and general health. Physicians underestimated the daily-life impact and unmet treatment need. Among 94 patients prescribed esketamine, improvements in clinical global impression occurred in 64.6-77.8% and in activities of daily living in 34-67%, indicating favorable outcomes.