Harding Lisa, Zhdanava Maryia, Teeple Amanda, Shah Aditi, Boonmak Porpong, Pilon Dominic, Joshi Kruti
Mood Institute, Milford, Connecticut.
Analysis Group, Inc., Montréal, Québec, Canada.
Clin Ther. 2025 Mar;47(3):189-195. doi: 10.1016/j.clinthera.2024.12.006. Epub 2025 Jan 4.
Major depressive disorder with acute suicidal ideation or behavior (MDSI) is a substantial humanistic, economic, and clinical burden on patients. Data on health care resource use (HRU) and costs among patients with MDSI initiated on esketamine nasal spray relative to traditional treatments are limited. This study sought to describe HRU and medical costs of patients with MDSI initiated on esketamine, electroconvulsive therapy (ECT), antidepressant with second-generation antipsychotic (SGA) augmentation, and antidepressant monotherapy in the United States.
Adults with MDSI from Merative® MarketScan® Commercial Databases (January 2016 to January 2022) were categorized into esketamine, ECT, SGA augmentation, and antidepressant monotherapy cohorts based on treatments initiated on or after August 5, 2020 (index date). Baseline period spanned 12 months before index date; follow-up period spanned from the index date till the end of data/health plan eligibility. Acute care HRU (inpatient and emergency department days) and medical costs excluding index treatment costs were described per-patient-per-month among all cohorts.
The number of patients in the respective cohorts was 122 for esketamine, 336 for ECT, 9958 for SGA augmentation, and 4496 for antidepressant monotherapy. Across cohorts, mean patient age ranged from 29.1 to 41.2 years, and the majority of patients were female (range, 57.2%-65.6%). During the follow-up period, mean all-cause acute care HRU was 0.59 days in the esketamine cohort, which trended lower than in the ECT (3.17 days) and SGA augmentation (0.92 days) cohorts, and higher than in the antidepressant monotherapy cohort (0.32 days). Mean acute care HRU decreased from baseline in the esketamine, SGA augmentation, and antidepressant monotherapy cohorts by 58%, 21%, and 37% and increased in the ECT cohort by 44%. Mean follow-up medical costs per-patient-per-month were $1869 in the esketamine cohort, which trended lower than in the ECT ($4624) and SGA augmentation ($2163) cohorts, and higher than in the antidepressant monotherapy ($863) cohort. Relative to baseline, medical costs decreased in all cohorts (esketamine, 50%; ECT, 22%; SGA augmentation, 17%; antidepressant monotherapy, 32%).
Acute care HRU and medical costs trended lower among patients with MDSI initiated on esketamine nasal spray versus ECT or SGA augmentation; HRU and costs reduced most from pretreatment levels among patients treated with esketamine nasal spray versus patients treated with ECT, SGA augmentation, and antidepressant monotherapy. Results of this study may aid physicians in determining optimal treatments for the vulnerable MDSI population.
伴有急性自杀意念或行为的重度抑郁症（MDSI）给患者带来了巨大的人文、经济和临床负担。与传统治疗方法相比，关于接受艾氯胺酮鼻喷雾剂治疗的MDSI患者的医疗资源使用（HRU）和成本的数据有限。本研究旨在描述美国接受艾氯胺酮、电休克治疗（ECT）、联用第二代抗精神病药物（SGA）的抗抑郁药以及抗抑郁药单药治疗的MDSI患者的HRU和医疗费用。
来自默克多市场扫描商业数据库（2016年1月至2022年1月）的患有MDSI的成年人，根据2020年8月5日及以后开始的治疗（索引日期），被分为艾氯胺酮、ECT、SGA联用和抗抑郁药单药治疗队列。基线期为索引日期前12个月；随访期从索引日期至数据/健康计划资格结束。描述了所有队列中每位患者每月的急性护理HRU（住院和急诊科天数）以及不包括索引治疗成本的医疗费用。
艾氯胺酮队列中有122名患者，ECT队列中有336名患者，SGA联用队列中有9958名患者，抗抑郁药单药治疗队列中有4496名患者。在各个队列中，患者的平均年龄在29.1至41.2岁之间，大多数患者为女性（范围为57.2%-65.6%）。在随访期间，艾氯胺酮队列中全因急性护理HRU的平均值为0.59天，这一趋势低于ECT队列（3.17天）和SGA联用队列（0.92天），高于抗抑郁药单药治疗队列（0.32天）。艾氯胺酮、SGA联用和抗抑郁药单药治疗队列中的急性护理HRU平均值从基线水平分别下降了58%、21%和37%，ECT队列则增加了44%。艾氯胺酮队列中每位患者每月的平均随访医疗费用为1869美元，这一趋势低于ECT队列（4624美元）和SGA联用队列（2163美元），高于抗抑郁药单药治疗队列（863美元）。相对于基线，所有队列的医疗费用均有所下降（艾氯胺酮，50%；ECT，22%；SGA联用，17%；抗抑郁药单药治疗，32%）。
与ECT或SGA联用相比，接受艾氯胺酮鼻喷雾剂治疗的MDSI患者的急性护理HRU和医疗费用呈下降趋势；与接受ECT、SGA联用和抗抑郁药单药治疗的患者相比，接受艾氯胺酮鼻喷雾剂治疗的患者的HRU和成本从治疗前水平下降最多。本研究结果可能有助于医生为脆弱的MDSI患者群体确定最佳治疗方案。
