Impact of social determinants of health on esketamine nasal spray initiation among patients with treatment-resistant depression in the United States.
Kristin Clemens, Maryia Zhdanava, Amanda Teeple, Arthur Voegel, Kruti Joshi, Aditi Shah, Cindy Chen, Dominic Pilon
Journal of managed care & specialty pharmacy 2025 DOI: 10.18553/jmcp.2025.24240 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 253,143 |
| Population | Adults with treatment-resistant depression and commercial or Medicare Advantage insurance, or Medicaid insurance, in the United States |
| Intervention | esketamine nasal spray |
| Duration | Baseline period 12 months before index date; follow-up from index date until end of health plan eligibility or data availability |
| Topics | Depression Esketamine |
| Keywords | Mental health Healthcare disparities Depression treatment Socioeconomic status Medical access |
| Citations | 4 |
| Key findings | Lower education and income combined reduced the chance of esketamine initiation by 37%, and females also had lower chances of initiation. |
Abstract
Disparities in mental health care access and health outcomes based on sociodemographic factors in the United States have been extensively documented. However, there is limited knowledge regarding these socioeconomic factors with respect to initiation of esketamine nasal spray, a novel therapy for treatment-resistant depression (TRD). To evaluate the association of socioeconomic factors with the initiation of esketamine nasal spray. Adults with TRD and commercial or Medicare Advantage (MA) insurance (Commercial-MA cohort) were included from Optum's deidentified Clinformatics Data Mart Database (January 2016-June 2022) and adults with Medicaid insurance (Medicaid cohort) were included from Merative MarketScan Multi-State Medicaid Database (January 2016-June 2022). The baseline period spanned 12 months before the index date (latter of evidence of TRD or US esketamine approval date); follow-up period spanned the index date until the end of health plan eligibility/data availability. Multivariate Cox proportional hazard models were used, separately for each cohort, to evaluate the association of characteristics with time to esketamine initiation; patients who did not initiate esketamine were censored at the end of follow-up. In the Commercial-MA cohort, 201,937 patients were included (75.0% female, mean age 62.3 years, 80.9% White, 82.8% having less than a bachelor's degree, 60.3% with a household income less than $75,000). Having both an education of less than a bachelor's degree and a household income less than $75,000 reduced the chance of esketamine initiation by 37% (hazard ratio [HR] = 0.63, P < 0.001). In the Medicaid cohort, 51,206 patients were included (77.8% female, mean age 43.2 years, 78.6% White). In both cohorts, chances of initiation trended to be lower in females (Commercial-MA: HR = 0.63, P < 0.001; Medicaid: HR = 0.68, P = 0.088), whereas racial or ethnic minorities had similar chances of initiation to White patients (Commercial-MA: HR = 1.23, P = 0.104; Medicaid: HR = 0.79, P = 0.376). Disparities in esketamine nasal spray initiation were observed based on education, income, and gender highlighting a potential health equity gap.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.
Citations in the library
Cited by 2
- Psilocybin-assisted therapy for treatment-resistant depression in the US: a model-based cost-effectiveness analysis Translational Psychiatry August 29, 2025
- Trials, trips, and tribulations: pathways for implementing psychedelic therapy in Ireland. The International Journal of Neuropsychopharmacology June 2, 2026
Cites 8
- Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study American Journal of Psychiatry May 21, 2019
- Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression JAMA Psychiatry June 5, 2019
- Esketamine Nasal Spray Plus Oral Antidepressant in Patients With Treatment-Resistant Depression The Journal of Clinical Psychiatry April 20, 2020
- Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression New England Journal of Medicine October 4, 2023
- Long-Term Safety and Maintenance of Response With Esketamine Nasal Spray in Participants With Treatment-Resistant Depression: Interim Results of the SUSTAIN-3 Study Neuropsychopharmacology May 12, 2023
and 3 more in the library