OBJECTIVES : Treatment-resistant depression (TRD) is defined as failure to respond to ≥2 antidepressant (AD) treatments with adequate dosage and duration. TRD is associated with negative impacts on quality of life and mortality as well as high economic burden. Moreover, TRD is an area of high unmet need with no new approved mechanisms of action for decades. Esketamine nasal spray was granted breakthrough designation for TRD by the Food and Drug Administration. This study evaluates the potential budget impact of esketamine for the treatment of TRD for a commercial plan in the United States.

METHODS : The study population was patients with moderate to severe TRD. For a health plan of 1 million members, the treatment-eligible population was estimated to be 7,544 patients for each year. This was based on the percent of adult members (77.2 %), prevalence rate for Major Depressive Disorder (MDD; 6.7%), percent of patients who are diagnosed or treated (65.3%), percent of MDD patients who are TRD (33.3%), and percent with moderate to severe TRD (67.0%). The budget impact of adding esketamine to a treatment mix of oral anti-depressants, antipsychotics, ECT, and rTMS was evaluated, assuming uptake in year 1 equivalent to ECT and then linear increases thereafter over 3 years. Medical care costs for patients in a depressive episode, response, and remission states were considered.

RESULTS : The total annual budget impact (including drug acquisition, procedural, monitoring, and medical care costs) was less than $1 million in the first year and less than $3 million by year 3. This corresponds to an average impact on per member per month of less than $0.15 over the three years.

CONCLUSIONS : Esketamine for the treatment of patients with moderate to severe TRD was estimated to have a modest impact on the annual budget of a commercial health plan.