Study Compares Work Productivity Loss, Cost Savings in Esketamine Nasal Spray vs Quetiapine Extended-Release for TRD

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CONFERENCE REPORTER

Investigators found in a recent study that esketamine nasal spray for treatment-resistant depression (TRD) results in greater work productivity loss (WPL) improvements and cost savings in comparison to quetiapine extended-release treatment. They shared these results in a poster presentation at Psych Congress 2023.

The poster presentation, titled “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,” described some of the results from the ESCAPE-TRD trial,¹ a long-term comparison of esketamine nasal spray and quetiapine extended-release in combination with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in patients with treatment-resistant major depressive disorder (MDD).²

TRD poses considerable direct and indirect cost burdens to employers in the United States,¹ with recent research finding that disproportionate health care costs and unemployment rates are associated with TRD.³ As such, the investigators sought to determine which treatment—esketamine nasal spray or quetiapine extended-release treatment—would result in the greatest cost savings and improvements in WPL.¹

To explore this, the investigators evaluated WPL among adults with TRD who were receiving esketamine nasal spray versus those who were receiving quetiapine extended-release treatment per US label dosing. The participants were randomized to receive either esketamine nasal spray (56/84 mg) or quetiapine extended-release treatment (150 to 300 mg) in combination with an ongoing SSRI or SNRI.¹

The investigators assessed WPL using Work Productivity and Activity Impairment (WPAI) scores among the participants who were employed. The mean change in WPL versus baseline and mean differences (MD) between the esketamine nasal spray and quetiapine extended-release 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 the US Bureau of Labor Statistics.¹

Upon evaluation at baseline, total WPL was 77.0% in the esketamine nasal spray group (N=150) and 72.5% in the quetiapine extended-release treatment group (N=151).¹

Upon evaluation at week 8, total WPL had decreased from baseline by 30.3% and 17.3% in the esketamine nasal spray and quetiapine extended-release treatment groups (MD=13.0%;95% confidence interval [CI]:6.3%-19.8%), resulting in respective weekly cost savings of $363 and $207 in the esketamine nasal spray and quetiapine extended-release treatment groups (MD=$156; 95%CI:$76-$237).¹

Upon evaluation at week 32, total WPL had decreased from baseline by 45.3% and 32.5% in the esketamine nasal spray and quetiapine extended-release treatment groups (MD=12.7%; 95%CI:4.7%-20.7%), with respective weekly cost savings of $543 and $390 (MD=$153; 95%CI:$57-$250).¹

“Among employed adults with TRD, [esketamine nasal spray] treatment was associated with significantly larger improvements in WPL and related costs compared to [quetiapine extended-release treatment], suggesting benefits from a patient wellbeing and employer perspective,” the investigators concluded.

The research outlined in this poster presentation was contributed by Amanda Teeple, MPH, of Janssen Scientific Affairs, LLC, and colleagues from Janssen, Analysis Group Inc, and Right Solutions Mental Health, LLC.

Learn more about important research and issues in psychiatry at the 2023 Annual Psychiatric Times World CME Conference on October 19 to 21, 2023. Register here.

References

1. Teeple A, Zhdanava M, Shah A, et al. 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. Poster presentation. Presented at Psych Congress 2023. Accessed September 8, 2023. https://www.national.psychcongress.com/

2. A long-term comparison of esketamine nasal spray versus quetiapine extended release, both in combination with a selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor, in participants with treatment resistant major depressive disorder (ESCAPE-TRD). ClinicalTrials.gov. Accessed September 8, 2023. https://classic.clinicaltrials.gov/ct2/show/NCT04338321

3. Zhdanava M, Pilon D, Ghelerter I, et al. The prevalence and national burden of treatment-resistant depression and major depressive disorder in the United States. J Clin Psychiatry. 2021;82(2):20m13699.