Program

In-person AND virtual! – We are pioneering a new conference format that will connect in-person and virtual audiences to create a unique experience. Matching the innovation that comes through our members’ work, ISPOR is pushing the boundaries of innovation to design an event that works in today’s quickly changing environment. 

In-person registration included the full virtual experience, and virtual-only attendees will be able to tune into live in-person sessions and/or watch captured in-person sessions on-demand in addition to having a variety of virtual-only sessions to attend.

Cost-Effectiveness of Esketamine Nasal Spray Compared to Intravenous Ketamine for Patients with Treatment-Resistant Depression in the US Utilizing Clinical Trial Efficacy and Real-World Effectiveness Estimates

Speaker(s)

Brendle M1, Robison R2, Malone DC1
1University of Utah, Salt Lake City, UT, USA, 2Novamind, Draper, UT, USA

Objective: The aim of our study was to estimate the incremental cost, benefits, and cost-effectiveness of esketamine nasal spray relative to intravenous ketamine for treatment-resistant depression (TRD) in the United States.

Methods: We used a Markov model with a 1-month cycle length to assess the cost-effectiveness ratios (ICER) of esketamine relative to ketamine for adults with TRD. Four health states were utilized (TRD, non-response/relapse, response, and all-cause mortality). We estimated the percentage of the cohort in each health state, quality-adjusted life years (QALYs), costs, and ICERs of esketamine relative to ketamine over a 3-year time horizon, from both the payer and patient perspectives. We ran the model using efficacy data from clinical trials and real-world effectiveness (RWE) data from a private outpatient psychiatric clinic. We performed one-way and probabilistic sensitivity analyses.

Results: Over a 3-year time horizon utilizing clinical trial efficacy, 10% more of the cohort was in response for ketamine compared to esketamine (+0.05 QALYs). Utilizing patient-level efficacy, 1.5% more of the cohort was in response for ketamine compared to esketamine (+0.01 QALY). Using clinical trial efficacy, esketamine costs were $176,320 higher (payer perspective) or $42,532 lower (patient perspective) than for ketamine. With RWE, esketamine costs were $172,919 higher (payer perspective) or $47,606 lower (patient) than for ketamine. Esketamine was dominated by ketamine under the payer perspective. For the patient perspective, base-case ICERs were above $150,000/QALY threshold. The probability that esketamine being cost-effective compared to ketamine was 0.0055 (clinical trial efficacy) and 0.35 (RWE).

Conclusions: In this decision analytic model evaluating esketamine versus ketamine for TRD, we found that esketamine is unlikely to be cost-effective under a payer perspective. Under a patient perspective, esketamine has similar effectiveness and is less costly compared to ketamine due to insurance coverage and manufacturer assistance program covering most of the cost of esketamine.

Code

EE51

Topic

Clinical Outcomes, Economic Evaluation

Topic Subcategory

Clinical Outcomes Assessment, Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Drugs, Mental Health