Cost-Effectiveness of Esketamine Nasal Spray for Patients With Treatment-Resistant Depression in the United States
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Overview
Model Description
Model Input Data
Parameter | Base case value | Uncertainty analysis range | Distribution | Source |
---|---|---|---|---|
General and demographic | ||||
Annual discount rate (%) | 3 | Sanders et al. (17) | ||
Time horizon (years) | 5 | 2–10a | ||
Annual mortality probability (%) | .40 | .38–.43 | Normal | Amos et al. (25), Arias et al. (26), Cuijpers et al. (27) |
Esketamine efficacy relative to usual care | Janssen (4) | |||
Response (relative risk) | 1.32 | 1.10–1.58 | Log-normal | |
Remission (relative risk) | 1.39 | 1.09–1.79 | Log-normal | |
Relapse (hazard ratio) | 1 | |||
Usual care efficacy by treatment line | Rush et al. (7) | |||
Remission probability (%) | ||||
Line 3 | 30.6 | 28.2–33.0 | Beta | |
Line 4 | 13.7 | 10.4–17.2 | Beta | |
Lines 5+ | 13.0 | 7.7–19.5 | Beta | |
Response probability (%) | ||||
Line 3 | 28.5 | 26.2–30.9 | Beta | |
Line 4 | 16.8 | 13.4–20.8 | Beta | |
Lines 5+ | 16.3 | 10.3–23.2 | Beta | |
Monthly relapse probability (%) | ||||
In remission, line 3 | 7.8 | 6.6–9.1 | Beta | |
In remission, line 4 | 7.7 | 4.1–12.6 | Beta | |
In remission, lines 5+ | 8.6 | 3.7–16.4 | Beta | |
In response, line 3 | 13.6 | 11.4–16.1 | Beta | |
In response, line 4 | 17.8 | 12.9–24.2 | Beta | |
In response, lines 5+ | 17.3 | 11.0–27.4 | Beta | |
Utility by health state | Sapin et al. (30) | |||
Nonresponse, relapse, initiation | .58 | .50–.66 | Normal | |
Response | .72 | .65–.79 | Normal | |
Remission | .85 | .83–.87 | Normal | |
Costs (2015 $) | ||||
Annual direct health care cost by treatment line | Amos et al. (25) | |||
Line 3 | 12,047 | 9,666–14,428 | Normal | |
Line 4 | 14,699 | 11,441–17,957 | Normal | |
Line 5 | 15,073 | 13,053–17,093 | Normal | |
Line 6 | 16,699 | 13,939–19,459 | Normal | |
Lines 7+ | 18,667 | 17,089–20,245 | Normal | |
Annual lost productivity cost by health state | Stewart et al. (38) and Bureau of Labor Statistics (39) | |||
Nonresponse, relapse, initiation | 11,573 | 8,063–15,083 | Normal | |
Response | 5,757 | 3,445–8,070 | Normal | |
Remission | 2,067 | 1,338–2,796 | Normal | |
Monthly costs of esketamine treatment | ||||
Medication costs | Janssen (4) and U.S. Department of Veterans Affairs (34) | |||
Month 1 | 5,572 | |||
Months 2+, response | 2,244 | |||
Months 2+, remission | 1,699 | |||
Months 2+, nonresponse, relapse | 1,966 | |||
Physician and medical assistant services | Janssen (4), Centers for Medicare and Medicaid Services (36), and Bureau of Labor Statistics (37) | |||
Month 1 | 685 | |||
Months 2+, response | 275 | |||
Months 2+, remission | 218 | |||
Months 2+, nonresponse, relapse | 246 | |||
Patient time | Janssen (4) and Bureau of Labor Statistics (39) | |||
Month 1 | 689 | |||
Months 2+, response | 276 | |||
Months 2+, remission | 219 | |||
Months 2+, nonresponse, relapse | 248 |
Demographics and mortality.
Esketamine efficacy.
Usual care efficacy.
Utility.
Costs.
Uncertainty and Sensitivity Analyses
Results
Model Validation
Five-Year Health and Economic Outcomes
Parameter | Usual care | Esketamine | Difference |
---|---|---|---|
Time spent in health state (%) | |||
Initiation, nonresponse, relapse | 72.3 | 66.9 | –5.4 |
Response | 2.4 | 2.0 | −.4 |
Remission | 25.3 | 31.1 | 5.7 |
QALYsa | 3.00 | 3.07 | .07 |
Total costs (2015 $) | |||
Societal perspective | 121,073 | 137,690 | 16,617 |
Health care sector perspective | 79,786 | 96,781 | 16,995 |
Cost components (2015 $) | |||
Esketamine treatment | |||
Medication | 16,352 | 16,352 | |
Physician and medical assistant services | 2,062 | 2,062 | |
Patient time | 2,074 | 2,074 | |
Other health care costs | 79,786 | 78,367 | –1,419 |
Lost productivity | 41,287 | 38,836 | –2,451 |
Incremental cost-effectiveness ratios ($/QALY) | |||
Societal perspective | 237,111 | ||
Health care sector perspective | 242,496 |
Uncertainty and Sensitivity Analyses
Discussion
Conclusions
Supplementary Material
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