Patients with treatment-resistant depression who received esketamine nasal spray experienced 43.2% more weeks with functional remission over 32 weeks compared to those taking quetiapine extended release, a difference of 2.0 weeks. Esketamine also led to an 11.9% reduction in productivity loss due to absenteeism and a 14.2% reduction in overall work productivity loss. Both treatments were taken alongside an ongoing SSRI or SNRI. The findings suggest that esketamine provides greater improvements in daily functioning and workplace productivity for this patient group.
An adjusted indirect comparison of treatment strategies for treatment-resistant depression found that esketamine nasal spray plus an antidepressant led to a higher probability of response (49.7%) and remission (33.6%) at six months compared with real-world polypharmacy strategies (26.8% response, 19.4% remission). Esketamine was about 1.86 times as likely to produce a response and 1.74 times as likely to produce remission. Threshold and sensitivity analyses indicated these results were robust to potential unmeasured confounders.
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.