Cost-Effectiveness of Esketamine Nasal Spray for Patients With Treatment-Resistant Depression in the United States
Open accessAbstract
OBJECTIVE: This study aimed to estimate the cost-effectiveness of esketamine, a novel intranasally dosed antidepressant, for patients in the United States with treatment-resistant depression. METHODS: A decision-analytic model parameterized with efficacy data from phase 3 randomized trials of esketamine was used to simulate the effects of treatment with esketamine versus oral antidepressants over a 5-year horizon, from both societal and health care sector perspectives. Outcomes included remission and response of depression, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) for esketamine. Value-based prices were calculated, defined as the per-dose price at which esketamine would become cost-effective given cost-effectiveness thresholds of $50,000/QALY, $100,000/QALY, and $150,000/QALY. Uncertainty in these outcomes was assessed with probabilistic sensitivity analyses. Key model parameters included the efficacy of esketamine versus oral antidepressants (relative risk of 1.39 for remission; 1.32 for response) and the monthly cost of esketamine ($5,572 for month 1; $1,699-$2,244 thereafter). RESULTS: Over 5 years, esketamine was projected to increase time in remission from 25.3% to 31.1% of life-years, resulting in a gain of 0.07 QALYs. Esketamine increased societal costs by $16,617 and health care sector costs by $16,995. Base case ICERs were $237,111/QALY (societal) and $242,496/QALY (health care sector). Probabilistic sensitivity analysis showed a greater than 95% likelihood that esketamine's ICER would be above $150,000/QALY. At a cost-effectiveness threshold of $150,000/QALY, esketamine's value-based price was approximately $140/dose (versus a current price of $240/dose). CONCLUSIONS: Esketamine is unlikely to be cost-effective for management of treatment-resistant depression in the United States unless its price falls by more than 40%.
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Independent groups conducting cost-effectiveness analyses have consistently determined that esketamine/Spravato exceeds standard cost-effectiveness thresholds and is currently too expensive for widespread or long-term use in the United States.
“Independent groups conducting cost-effectiveness analyses have consistently determined that esketamine/Spravato exceeds standard cost-effectiveness thresholds and is currently too expensive for widespread or long-term use in the United States [107,108].”
From Pharmacotherapies Targeting GABA-Glutamate Neurotransmission for Treatment-Resistant Depression (2023) · cites this paper as [108]
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Economic Evaluation of Mental Health Interventions
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ATP-binding cassette transporter polymorphisms and the pharmacokinetics of oral esketamine
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The role of cytochrome P450 polymorphisms in the pharmacokinetics of oral esketamine
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THE IMPACT OF INTRANASAL ESKETAMINE ON TREATMENT-RESISTANT DEPRESSION: A SYSTEMATIC REVIEW
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- Authors
- Ross, E. L., & Soeteman, D. I.
- Affiliations
- Harvard University (US)
- Venue
- Psychiatric Services
- Published
- 2020-10-01
- Volume
- 71
- Issue
- 10
- Pages
- 988-997
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- PMC
- PMC7920520
- OpenAlex
- W3040446518
- Cited by
- 51
- References
- 49
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 3 · 2023: 7 · 2022: 8 · 2021: 7 · 2020: 2
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R25MH094612)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- esketamine, treatment-resistant depression, cost-effectiveness, value-based pricing, incremental cost-effectiveness ratio, quality-adjusted life years, oral antidepressant, drug pricing
- MeSH terms
- Cost-Benefit Analysis, Depression, Humans, Ketamine, United States, Nasal Sprays
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