Esketamine Nasal Spray: A New Hope for Patients with Major Depression and Suicidal Ideation
Article Title: “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”
Author: Lisa Harding, Maryia Zhdanava, Amanda Teeple, Aditi Shah, Porpong Boonmak, Dominic Pilon, Kruti Joshi.
Publication Date: Jan 2025
Background
Major Depressive Disorder (MDD) is a significant public health challenge, with nearly 9% of adults in the U.S. experiencing the condition annually. A particularly severe subset of patients includes those with acute suicidal ideation or behaviour (MDSI), who are at a high risk of self-harm and suicide attempts. Traditionally, treatment options for these individuals include antidepressants, second-generation antipsychotics (SGAs), and electroconvulsive therapy (ECT).
Esketamine nasal spray, a novel fast-acting antidepressant, was approved in the U.S. in 2020 for MDSI patients in combination with an oral antidepressant. While prior research demonstrated esketamine’s effectiveness in treatment-resistant depression, real-world data on its impact in MDSI patients remained scarce. This study aimed to bridge that gap by analysing healthcare resource use (HRU) and medical costs associated with esketamine compared to traditional treatments.
Study Overview
This retrospective study examined insurance claims data from the Merative® MarketScan® Commercial Database (2016–2022) to compare HRU and medical costs for patients treated with:
- Esketamine nasal spray
- Electroconvulsive therapy (ECT)
- Antidepressants with SGA augmentation
- Antidepressant monotherapy
A total of 14,912 patients were included, with 122 in the esketamine group. The study followed patients from treatment initiation to the end of their insurance eligibility, examining inpatient/emergency department visits and associated medical costs.
Key Findings
-
Esketamine users had fewer acute care hospitalisations than ECT or SGA users
- Patients in the esketamine group averaged 0.59 inpatient/emergency care days per month, lower than the ECT group (3.17 days) and SGA augmentation group (0.92 days).
-
Medical costs were significantly reduced post-treatment for esketamine patients
- Esketamine users’ monthly medical costs fell by 50% (from $3,746 to $1,869).
- In comparison, medical costs fell by 22% for ECT users, 17% for SGA users, and 32% for monotherapy users.
-
Esketamine users showed greater adherence difficulties
- While 51.6% of patients completed the recommended 8 treatment sessions, many exceeded the recommended time frame, with session gaps ranging from 8.1 to 13.6 days (instead of the twice-weekly schedule).
-
Outpatient visits increased after esketamine initiation
- Esketamine users’ outpatient visits rose from 4.32 to 5.69 visits per month, indicating increased engagement in follow-up care.
Discussion
These findings highlight esketamine’s potential as an effective treatment for MDSI, with fewer hospital stays and lower healthcare costs compared to traditional interventions like ECT. Notably, esketamine reduced acute care use by 58%, whereas ECT patients had a 44% increase in hospital days post-treatment.
However, adherence to esketamine’s treatment schedule remains a challenge. Many patients did not follow the twice-weekly dosing schedule, which may impact treatment efficacy. Addressing logistical barriers, such as access to treatment centres and cost considerations, could improve adherence rates.
Implications
The findings of this study suggest that esketamine nasal spray could be a clinically and economically valuable treatment for patients with major depression and suicidal ideation. Compared to traditional interventions like ECT and SGA augmentation, esketamine was associated with lower hospitalisation rates and reduced healthcare costs, making it a potentially more efficient treatment option. Given its rapid action, esketamine may be particularly beneficial for patients experiencing acute suicidal crises, where immediate intervention is crucial. However, challenges related to patient adherence indicate that further efforts are needed to ensure that individuals complete their treatment regimen as prescribed. By addressing barriers such as treatment access, education, and aftercare support, esketamine could become a more widely utilised and impactful therapy for those at high risk of suicide.
Potential Application
This research highlights esketamine’s potential not just as a clinical treatment, but as a structured, integrative therapy that can support individuals in severe psychological distress. Additionally, integrating post-treatment support—such as counselling, mindfulness practices, and peer support groups—could help address adherence challenges and improve long-term outcomes. As public and medical awareness of psychedelic therapies grows, clinics focusing on holistic healing may find that esketamine-based interventions align well with their mission, offering rapid relief for individuals in crisis while complementing deeper, long-term healing approaches.
Conclusions
Esketamine nasal spray offers a promising treatment pathway for patients with severe depression and suicidal ideation, reducing both acute care hospitalisation and overall medical costs. Compared to traditional treatments like ECT and SGAs, esketamine demonstrates superior cost-effectiveness and reduced hospitalisation rates, though patient adherence remains an area for improvement. As psychedelic-assisted therapies gain traction, esketamine presents a viable option for immediate intervention in psychiatric emergencies.
Reference:
Harding, L., Zhdanava, M., Teeple, A., Shah, A., Boonmak, P., Pilon, D., & Joshi, K. (2024). 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. https://doi.org/10.1016/j.clinthera.2024.12.006
You may also like
