Costs Associated with Work Productivity Loss of Patients with Treatment-Resistant Depression Treated with Esketamine Nasal Spray Versus Quetiapine Extended Release: ESCAPE-TRD Subgroup Analysis

This work was sponsored by Janssen Scientific Affairs, LLC BACKGROUND: Treatment resistant depression (TRD) poses significant direct and indirect cost burden to US employers. This ESCAPE-TRD trial subgroup analysis evaluated work productivity loss (WPL) among patients with TRD receiving esketamine nasal spray (ESK) versus quetiapine extended-release (QUE) per US label dosing. METHODS: Adults with TRD randomized to ESK (56/84mg) or QUE (150-300mg) treatment combined with an ongoing selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor were included. WPL was assessed using Work Productivity and Activity Impairment (WPAI) scores among employed patients. Mean change in WPL versus baseline (treatment initiation date), and mean differences (MD) between ESK and QUE groups, were reported at weeks 8 through 32 post-baseline using mixed models for repeated measurements. Per-patient indirect cost savings were estimated using mean US$2021 weekly wages from US Bureau of Labor Statistics. RESULTS: At baseline, total WPL was 77.0% in the ESK group (Nf150) and 72.5% in the QUE group (Nf151). By week 8, total WPL decreased from baseline by 30.3% and 17.3% in the ESK and QUE groups (MD=13.0%;95% confidence interval [CI]:6.3%-19.8%) resulting in weekly cost savings of $363 and $207 in the ESK and QUE groups, respectively (MD=$156; 95%CI:$76-$237). By week 32, total WPL decreased from baseline by 45.3% and 32.5% in the ESK and QUE groups (MD=12.7%; 95%CI:4.7%-20.7%), with weekly cost savings of $543 and $390, respectively (MD=$153; 95%CI:$57-$250). CONCLUSION: Among employed adults with TRD, ESK treatment was associated with significantly larger improvements in WPL and related costs compared to QUE, suggesting benefits from a patient wellbeing and employer perspective.