Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
Analysis Group, Inc., Montréal, QC, Canada.
J Med Econ. 2023 Jan-Dec;26(1):422-429. doi: 10.1080/13696998.2023.2188845.
To describe real-world use of esketamine (ESK) intranasal spray and healthcare outcomes among patients with treatment-resistant depression (TRD) in the United States (US).
Adults with TRD initiated on ESK (index date) between 5 March 2019 (US approval date for TRD) and 31 October 2020 were sampled from IBM MarketScan Research Databases. TRD was defined as claims for ≥2 unique antidepressants during the same major depressive episode. Subgroups of the TRD cohort with comorbid cardiometabolic conditions, pain, anxiety disorder, and substance use disorder (SUD) were identified. Patients had ≥6 months of continuous health plan eligibility pre- and post-index.
The TRD cohort comprised 269 patients; comorbidity subgroups included 123 (cardiometabolic), 144 (pain), 189 (anxiety disorder), and 58 (SUD) patients. Proportion of patients completing ≥8 ESK sessions (number of sessions in induction phase) was 61.3% in the TRD cohort and ranged from 60.2% (cardiometabolic subgroup) to 72.4% (SUD subgroup) in subgroups. Median frequency of induction sessions was every 5-8 days among the TRD cohort and subgroups. Mean mental health-related inpatient costs reduced from pre- to post-index periods in the TRD cohort (mean ± standard deviation [median] costs per-patient-per-6-months: $3,480 ± $13,328 [$0] pre-ESK initiation; $3,262 ± $16,666 [$0] post-ESK initiation; mean difference: -$218) and subgroups (largest decrease in cardiometabolic subgroup: $4,864 ± $14,271 [$0]; $2,792 ± $15,757 [$0]; -$2,072). Mean mental health-related emergency department (ED) costs decreased in the TRD cohort ($608 ± $2,525 [$0]; $269 ± $1,143 [$0]; -$339) and subgroups (largest decrease in the SUD subgroup: $1,403 ± $3,752 [$0]; $351 ± $868 [$0]; -$1,052).
This is a descriptive analysis; sample size for some comorbidity subgroups is small.
The majority of patients completed ESK induction phase, and most dosing intervals were longer than the label recommendation. In this descriptive analysis, mental health-related inpatient and ED costs trended lower post-ESK initiation.
描述美国（美国）治疗抵抗性抑郁症（TRD）患者中使用 Esketamine（ESK）鼻内喷雾的真实世界情况和医疗保健结果。
2019 年 3 月 5 日（TRD 的美国批准日期）至 2020 年 10 月 31 日期间，从 IBM MarketScan 研究数据库中抽取符合 TRD 起始 ESK（索引日期）的成年人。TRD 的定义是在同一主要抑郁发作期间，有≥2 种独特的抗抑郁药的索赔。确定了伴有合并症心血管代谢疾病、疼痛、焦虑症和物质使用障碍（SUD）的 TRD 队列亚组。患者在索引前和索引后至少有 6 个月的连续健康计划资格。
TRD 队列包括 269 名患者；合并症亚组包括 123 名（心血管代谢）、144 名（疼痛）、189 名（焦虑症）和 58 名（SUD）患者。TRD 队列中完成≥8 次 ESK 治疗（诱导期的治疗次数）的患者比例为 61.3%，亚组中为 60.2%（心血管代谢亚组）至 72.4%（SUD 亚组）。TRD 队列和亚组中诱导治疗的中位数频率为每 5-8 天一次。TRD 队列中（每个患者每 6 个月的平均精神健康相关住院费用）在 ESK 启动前（每患者每 6 个月的平均费用±标准差[中位数]：$3480 ± $13328 [$0]；ESK 启动后：$3262 ± $16666 [$0]；平均差异：-$218）和亚组（心血管代谢亚组降幅最大：$4864 ± $14271 [$0]；$2792 ± $15757 [$0]；-$2072）的精神健康相关住院费用从治疗前到治疗后均有所降低。TRD 队列中（每个患者每 6 个月的平均精神健康相关急诊费用）的平均精神健康相关急诊费用（$608 ± $2525 [$0]；$269 ± $1143 [$0]；-$339）和亚组（SUD 亚组降幅最大：$1403 ± $3752 [$0]；$351 ± $868 [$0]；-$1052）的精神健康相关急诊费用均有所降低。
这是一项描述性分析；一些合并症亚组的样本量较小。
大多数患者完成了 ESK 诱导期，大多数剂量间隔均长于标签推荐。在这项描述性分析中，ESK 启动后精神健康相关住院和急诊费用呈下降趋势。
