Characteristics of Commercially Insured Patients Initiated on Esketamine Nasal Spray in a Real-World Setting

BACKGROUND: Esketamine nasal spray was approved for adults with treatment-resistant depression on 03/05/2019. Real-world data on patients initiated on esketamine is limited.

METHODS: Adults with major depressive disorder (MDD) were identified in the MarketScan® Databases from 01/01/2010 to 02/29/2020. The index date was the first claim for esketamine. Patient characteristics, including demographics, specialized mental-health service and pharmacotherapy use, and costs were described in the 6-month pre-index period. 

RESULTS: A total of 356 patients initiated on esketamine (mean age 44.7 years, 59.3% female) were identified. Nearly all (96.1%) had ≥1 mental-health related outpatient visit pre-index; the most common outpatient visit closest to esketamine initiation was with a psychiatrist (48.0%). Overall, 77.2% of patients had ≥1 psychiatrist visit in the 6-months pre-index. Among all patients, 66.3% had evidence of severe MDD and 6.5% had suicidal ideation/behavior. Those who received outpatient care for MDD (88.8%) predominantly received care from a specialist or in a mental health-care setting (78.2%). The majority of patients had ≥1 psychotherapy (75.6%) visit. Nearly two-thirds (62.4%) received ≥2 antidepressants and 80.1% received ≥1 non-antidepressant augmentation agent, including atypical antipsychotics (43.5%), psychostimulants (36.5%), and anticonvulsants (25.6%) within 6 months pre-index.  Mean monthly all-cause healthcare costs were $2,977, driven by outpatient ($1,407) and pharmacy ($749) costs; 51.7% of all-cause costs were mental-health related.

CONCLUSIONS: Commercially insured adults initiated on esketamine in a real-world setting demonstrate severe depressive symptoms with high utilization of specialized mental-health care and substantial medication burden prior to esketamine initiation.