Characteristics of Patients with Major Depressive Disorder and Acute Suicidal Ideation or Behavior Initiated on Esketamine or Traditional Therapies in the United States

Abstract: BACKGROUND: Adults with major depressive disorder with acute suicidal ideation or behavior (SIB; MDSI) initiated on esketamine or traditional therapies were described to understand variation in patient profiles. METHODS: Adults with diagnosed MDSI selected from IBM® MarketScan® Commercial Database (01/2016-01/2022) were categorized into cohorts based on treatments initiated on or after 08/05/2020 (esketamine approval for MDSI): esketamine, electroconvulsive therapy (ECT), antipsychotic augmentation (AP) and antidepressant monotherapy (AD). Patients were characterized over the 12-month pre-treatment initiation period. RESULTS: Esketamine, ECT, AP and AD cohorts included 122, 336, 9,958, and 4,946 patients (mean age: 36.1, 41.2, 33.1, and 29.1 years; 65.6%, 64.3%, 63.0%, and 57.2% female), respectively. Mean time from most recent SIB diagnosis to treatment initiation was 3.4, 1.2, 2.5, and 2.1 months for the esketamine, ECT, AP and AD cohorts. Treatment-resistant depression (≥2 lines of antidepressant therapy) pre-treatment initiation was observed in 59.0%, 44.6%, 27.3%, and 2.8% of the esketamine, ECT, AP, and AD cohorts. Psychotherapy use was observed in 87.7%, 81.5%, 67.4%, and 43.9% of the esketamine, ECT, AP, and AD cohorts. Mean monthly number of inpatient days was 1.23, 2.01, 0.96, and 0.38 in the esketamine, ECT, AP, and AD cohorts. Mean monthly medical costs were $3,748, $5,930, $2,618, and $1,262 in the esketamine, ECT, AP, and AD cohorts. Inpatient costs represented 55.0%, 73.3%, 60.7%, and 62.4% of medical costs in the esketamine, ECT, AP, and AD cohorts. CONCLUSION: Patients with MDSI initiating esketamine and ECT were most similar, while patients initiating traditional pharmacotherapy appeared less severe.Short Description: Characteristics of adults with major depressive disorder with acute suicidal ideation or behavior initiated on esketamine, electroconvulsive therapy (ECT), antipsychotic augmentation, and antidepressant monotherapy were described during the 12-month period pre-therapy initiation. Patients with MDSI initiating esketamine and ECT were most similar in terms of clinical profile, while patients initiating traditional pharmacotherapy appeared to utilize fewer healthcare resources and have lower costs pre-therapy initiation.Name of Sponsoring Organization(s): Janssen Scientific Affairs, LLC