This secondary analysis (n=321) of the ESCAPE-TRD trial compared work productivity loss (WPL) and related costs in patients with treatment-resistant depression (TRD) receiving esketamine nasal spray (56mg or 84mg) versus quetiapine (atypical antipsychotic) extended release, both combined with an oral antidepressant. By week 8, WPL decreased by 30.3% with esketamine and 17.3% with quetiapine, leading to a cost savings difference of $156 per week. By week 32, WPL reductions were 45.3% (esketamine) and 32.5% (quetiapine), with a weekly cost savings difference of $153.
Abstract of Esketamine Nasal Spray vs Quetiapine Extended-Release
Objective This post hoc analysis of the ESCAPE-TRD trial compared work productivity loss (WPL) and related costs among patients with treatment-resistant depression (TRD) receiving esketamine nasal spray or quetiapine extended release in combination with an oral antidepressant.
Methods Adults with TRD randomized to receive esketamine (56/84 mg) or quetiapine (150–300 mg) combined with ongoing antidepressant therapy were included. WPL was assessed using the Work Productivity and Activity Impairment questionnaire. Least squares (LS) mean WPL change versus baseline (treatment initiation date), and LS mean differences (MDs) between esketamine and quetiapine cohorts were reported at weeks 8–32 of treatment using mixed models for repeated measurements. Per patient productivity cost savings were estimated using mean 2021 weekly wages from US Bureau of Labor Statistics.
Results The esketamine cohort included 165 patients, and quetiapine cohort included 156 patients. At baseline, total WPL was 77.0% and 72.5% in the esketamine and quetiapine cohorts, respectively. By week 8, total WPL decreased from baseline by 30.3 and 17.3 percentage points (pp) in the esketamine and quetiapine cohorts (MD = 13.0 pp; 95% confidence interval [CI], 6.3–19.8 pp), resulting in weekly cost savings of $363 and $207 (MD = $156; 95% CI, $76–$237), respectively. By week 32, total WPL decreased from baseline by 45.3 pp and 32.5 pp in the esketamine and quetiapine cohorts (MD = 12.7 pp; 95% CI, 4.7–20.7 pp), with weekly cost savings of $543 and $390 (MD = $153; 95% CI, $57–$250), respectively.
Conclusion Among employed adults with TRD, esketamine treatment was associated with significantly larger improvements in WPL and related costs compared to quetiapine, suggesting greater benefits from patient well-being and employer perspectives.
Authors: Kristin Clemens, Amanda Teeple, Maryia Zhdanava, Aditi Shah, Kruti Joshi, Jozefien Buyze, Dominic Pilon, Hannah E. Bowrey & Yordan Godinov
Summary of Esketamine Nasal Spray vs Quetiapine Extended-Release
Major depressive disorder (MDD) is a prevalent chronic illness in the United States, with approximately 9 million adults receiving treatment in 2017. A significant subset of these patients, about one-third, experience treatment-resistant depression (TRD), defined as MDD that does not respond to two or more adequate antidepressant treatments. TRD predominantly affects individuals in their prime working years, leading to substantial disability and work productivity loss (WPL). The economic impact is considerable, with MDD and TRD contributing to increased unemployment and decreased productivity.
Esketamine nasal spray has emerged as a novel treatment option for TRD. Administered intranasally, esketamine offers a different mechanism of action compared to traditional antidepressants. The ESCAPE-TRD trial previously evaluated the efficacy of esketamine nasal spray in combination with an oral antidepressant versus quetiapine extended-release (XR) combined with an oral antidepressant in patients with TRD. While the primary outcomes focused on depressive symptom reduction, the impact on work productivity and associated costs remained underexplored.
Methods
Find this paper
https://doi.org/10.4088/jcp.24m15425
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Cite this paper (APA)
Clemens, K., Teeple, A., Zhdanava, M., Shah, A., Joshi, K., Buyze, J., ... & Godinov, Y. (2025). Esketamine Nasal Spray vs Quetiapine Extended-Release: Examining Work Productivity Loss and Related Costs in Patients With Treatment-Resistant Depression.
Study details
Compounds studied
Ketamine
Topics studied
Depression
Treatment-Resistant Depression
Economics
Study characteristics
Open-Label
Randomized
Re-analysis
Participants
321
Humans
Compound Details
The psychedelics given at which dose and how many times
Ketamine 56 - 84mg
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Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression
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Linked Clinical Trial
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