Cost-per-remitter for esketamine nasal spray versus quetiapine for treatment-resistant depression.

Estimate the cost-per-remitter with esketamine nasal spray plus an oral antidepressant (ESK NS + OAD) versus quetiapine extended release plus an oral antidepressant (QTP XR + OAD) among adults with treatment-resistant depression (TRD). An Excel-based model was developed to estimate the cost-per-remitter for ESK NS + OAD and QTP XR + OAD from the perspective of a US commercial insurance plan and Medicaid. Remission and response rates were estimated in 4-week intervals over 32 weeks using data from the ESCAPE-TRD phase IIIb clinical trial comparing ESK NS + OAD versus QTP XR + OAD in adults with TRD. Direct healthcare costs were sourced from health economic literature and the RED BOOK drug pricing database. Indirect costs were derived from a separate analysis of ESCAPE-TRD using the Work Productivity and Activity Impairment: Depression questionnaire. Adults not remitting/responding either stayed on current treatment or discontinued current treatment and initiated either augmented therapy with antipsychotics or repetitive transcranial magnetic stimulation. In a scenario analysis, all individuals who did not achieve response and discontinued treatment initiated repetitive transcranial magnetic stimulation. The remission rate at 32 weeks was 50% for adults receiving ESK NS + OAD and 33% for adults receiving QTP XR + OAD. The cost-per-remitter for ESK NS + OAD compared with QTP XR + OAD was $3102.17 lower in the commercial setting and $456.12 lower in the Medicaid setting. Under the scenario analysis, the cost-per-remitter for ESK NS + OAD compared with QTP XR + OAD was $15,133.66 lower in the commercial setting and $12,487.62 lower in the Medicaid setting. The findings suggest that ESK NS + OAD is a cost-effective treatment for adults with TRD compared with QTP XR + OAD in the commercial and Medicaid settings.