Esketamine nasal spray for major depressive disorder with acute suicidal ideation or behavior: description of treatment access, utilization, and claims-based outcomes in the United States.
Maryia Zhdanava, Amanda Teeple, Dominic Pilon, Aditi Shah, Gabrielle Caron-Lapointe, Kruti Joshi
Journal of medical economics 2023 DOI: 10.1080/13696998.2023.2208993 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective observational claims-based analysis Peer reviewed |
|---|---|
| Sample size | 269 |
| Population | Adults with major depressive disorder with suicidal ideation or behavior who had at least one esketamine nasal spray claim |
| Intervention | Esketamine nasal spray |
| Duration | 6 months pre-index and 6 months post-index; data covered up to 24 months of esketamine use |
| Topics | Depression Esketamine |
| Keywords | I10 I11 Access to care Costs Healthcare resource use Real-world use Suicidal ideation Treatment patterns |
| Key findings | Nearly half of patients (46.8%) had their first esketamine nasal spray pharmacy claim approved, while 38.7% were rejected and 14.5% abandoned; only 45.0% of initiators reached the label-recommended 8 sessions, and the mean time to the 8th session was 85.0 days versus the recommended 28 days. All-cause healthcare resource use and mean monthly total healthcare costs were lower in the 6 months after initiation ($6,486) than in the 6 months before ($8,371). |
Abstract
To describe real-world esketamine nasal spray access and use as well as healthcare resource use (HRU) and costs among adults with evidence of major depressive disorder (MDD) with suicidal ideation or behavior (MDSI). Adults with ≥1 claim for esketamine nasal spray and evidence of MDSI 12 months before/on the date of esketamine initiation (index date) were selected from Clarivate's Real World Data product (01/2016-03/2021). Patients initiated esketamine on/after 03/05/2019 (esketamine approval for treatment-resistant depression; later approved for MDSI on 08/05/2020) were included in the overall cohort. Esketamine access (measured as approved/abandoned/rejected claims) and use were described post-index; HRU and healthcare costs (2021 USD) were described over 6 months pre- and post-index. Among 269 patients in the overall cohort with esketamine pharmacy claims, 46.8% had the first pharmacy claim approved, 38.7% had it rejected, and 14.5% abandoned their claim; 169 patients were initiated on esketamine in the overall cohort (mean age 40.9 years, 62.1% female); 45.0% had ≥8 esketamine treatment sessions (recommended per label) with a mean [median] of 85.0 [58.5] days from index to 8th session (per label 28 days). Among 115 patients with ≥6 months of data post-index, in the 6-month pre- and post-index, respectively, 37.4 and 19.1% had all-cause inpatient admissions, 42.6 and 33.9% had emergency department visits, 92.2 and 81.7% had outpatient visits; mean ± standard deviation all-cause monthly total healthcare costs were $8,371±$15,792 and $6,486±$7,614, respectively. This was a descriptive claims-based analysis; no formal statistical comparisons were performed due to limited sample size as data covered up to 24 months of esketamine use in the US clinical setting. Nearly half of patients experience access issues with first esketamine nasal spray treatment session. All-cause HRU and healthcare costs trend lower in the 6 months after relative to 6 months before esketamine initiation.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.
Citations in the library
Cited by 7
- Use of Esketamine Nasal Spray in Patients with Treatment-Resistant Depression in Routine Practice: A Real-World French Study. Depression and Anxiety 2024
- Spravato for Treatment-Resistant Depression: Efficacy and Sexual Side Effect Profile. Neuropsychiatric Disease and Treatment 2025
- Health Care Resource Use and Medical Costs Among Patients With Major Depressive Disorder and Acute Suicidal Ideation or Behavior Initiated on Esketamine Nasal Spray or Traditional Treatments in the United States. Clinical Therapeutics March 1, 2025
- New pharmacotherapies to tackle the unmet needs in bipolar disorder: a focus on acute suicidality. Expert Opinion on Pharmacotherapy March 1, 2024
- Effectiveness and factors associated with esketamine response during the 4-week induction period for treatment-resistant depression: post-hoc analysis of the real-world ESKALE study. Journal of Psychiatric Research June 1, 2026
and 2 more in the library
Cites 3
- Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study American Journal of Psychiatry April 16, 2018
- Esketamine Nasal Spray for Rapid Reduction of Depressive Symptoms in Patients With Major Depressive Disorder Who Have Active Suicide Ideation With Intent: Results of a Phase 3, Double-Blind, Randomized Study (ASPIRE II) The International Journal of Neuropsychopharmacology August 26, 2020
- Esketamine Nasal Spray for Rapid Reduction of Major Depressive Disorder Symptoms in Patients Who Have Active Suicidal Ideation With Intent The Journal of Clinical Psychiatry May 11, 2020