Real‐World Effectiveness and Cost‐Differential of Intranasal Esketamine Versus Intramuscular Ketamine
Psychiatric Research and Clinical Practice July 2, 2026 Kush V. Bhatt, Tara Austin, Danny Alam et al.
Intramuscular (IM) ketamine is as effective as intranasal (IN) esketamine for treatment-resistant depression, with comparable safety and a dramatically lower cost. In a retrospective cohort of 179 Veterans, the difference in depression symptom improvement was only 0.04 points on the PHQ-9, well within the non-inferiority margin. PTSD symptom reductions were also similar, and rates of emergency department visits or hospitalizations did not differ significantly. The cost per eight-treatment course was $6069 for IN esketamine versus $647 for IM ketamine, driven primarily by the cost of the nasal spray. These results indicate that IM ketamine could be a high-value alternative that expands access to care.