This retrospective cohort study (n=14,912) examines healthcare resource use (HRU) and costs among patients with major depressive disorder (MDD) and acute suicidal ideation or behaviour (SI) initiated on esketamine nasal spray, ECT, SGA augmentation, or antidepressant monotherapy in the U.S. Esketamine-treated patients (n=122) had lower acute care HRU (0.59 days) and costs ($1869/month) compared to ECT (3.17 days, $4624) and SGA augmentation (0.92 days, $2163), but higher than monotherapy (0.32 days, $863). Esketamine reduced HRU (58%) and costs (50%) most significantly from baseline.
Abstract of Health Care Resource Use and Medical Costs Among Patients … Initiated on Esketamine Nasal Spray or Traditional Treatments in the US
“Purpose Major depressive disorder with acute suicidal ideation or behavior (MDSI) is a substantial humanistic, economic, and clinical burden on patients. Data on health care resource use (HRU) and costs among patients with MDSI initiated on esketamine nasal spray relative to traditional treatments are limited. This study sought to describe HRU and medical costs of patients with MDSI initiated on esketamine, electroconvulsive therapy (ECT), antidepressant with second-generation antipsychotic (SGA) augmentation, and antidepressant monotherapy in the United States.
Methods Adults with MDSI from Merative® MarketScan® Commercial Databases (January 2016 to January 2022) were categorized into esketamine, ECT, SGA augmentation, and antidepressant monotherapy cohorts based on treatments initiated on or after August 5, 2020 (index date). Baseline period spanned 12 months before index date; follow-up period spanned from the index date till the end of data/health plan eligibility. Acute care HRU (inpatient and emergency department days) and medical costs excluding index treatment costs were described per-patient-per-month among all cohorts.
Findings The number of patients in the respective cohorts was 122 for esketamine, 336 for ECT, 9958 for SGA augmentation, and 4496 for antidepressant monotherapy. Across cohorts, mean patient age ranged from 29.1 to 41.2 years, and the majority of patients were female (range, 57.2%–65.6%). During the follow-up period, mean all-cause acute care HRU was 0.59 days in the esketamine cohort, which trended lower than in the ECT (3.17 days) and SGA augmentation (0.92 days) cohorts, and higher than in the antidepressant monotherapy cohort (0.32 days). Mean acute care HRU decreased from baseline in the esketamine, SGA augmentation, and antidepressant monotherapy cohorts by 58%, 21%, and 37% and increased in the ECT cohort by 44%. Mean follow-up medical costs per-patient-per-month were $1869 in the esketamine cohort, which trended lower than in the ECT ($4624) and SGA augmentation ($2163) cohorts, and higher than in the antidepressant monotherapy ($863) cohort. Relative to baseline, medical costs decreased in all cohorts (esketamine, 50%; ECT, 22%; SGA augmentation, 17%; antidepressant monotherapy, 32%).
Implications Acute care HRU and medical costs trended lower among patients with MDSI initiated on esketamine nasal spray versus ECT or SGA augmentation; HRU and costs reduced most from pretreatment levels among patients treated with esketamine nasal spray versus patients treated with ECT, SGA augmentation, and antidepressant monotherapy. Results of this study may aid physicians in determining optimal treatments for the vulnerable MDSI population.”
Authors: Lisa Harding, Maryia Zhdanava, Amanda Teeple, Aditi Shah, Porpong Boonmak, Dominic Pilon & Kruti Joshi
Summary of Health Care Resource Use and Medical Costs Among Patients … Initiated on Esketamine Nasal Spray or Traditional Treatments in the US
Major depressive disorder (MDD) affects 8.8% of the adult population annually in the United States, with a significant proportion experiencing suicidal ideation or behaviour during depressive episodes. Among those, nearly 10% engage in plans or attempts at self-harm. MDD with acute suicidal ideation or behaviour (MDSI) imposes substantial humanistic, economic, and clinical burdens, affecting patients’ quality of life and straining healthcare resources. Caregivers of individuals with MDSI also report psychosocial challenges.
Traditional treatments for MDD, including antidepressants, second-generation antipsychotics (SGAs), and electroconvulsive therapy (ECT), have shown varied efficacy in managing MDSI. Esketamine, a novel nasal spray approved in 2020, has emerged as a rapid-acting option for MDSI when combined with oral antidepressants. Unlike traditional registration trials, esketamine’s approval relied on Phase III trials targeting patients at imminent risk of suicide, demonstrating significant symptom reduction within 24 hours.
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Harding, L., Zhdanava, M., Teeple, A., Shah, A., Boonmak, P., Pilon, D., & Joshi, K. (2025). Health Care Resource Use and Medical Costs Among Patients With Major Depressive Disorder and Acute Suicidal Ideation or Behavior Initiated on Esketamine Nasal Spray or Traditional Treatments in the United States. Clinical Therapeutics.