Budget Impact Analysis of Esketamine Nasal Spray in a Sub-Population of Adults With Major Depressive Disorder and High Unmet Need: Payer Perspective in the United States

Background: Esketamine nasal spray (ESK) plus comprehensive standard of care (SOC) vs placebo plus SOC was studied in two phase 3 antidepressant clinical trials among a sub-population of adults with major depressive disorder and high unmet need (NCT03039192, NCT03097133).

Objective: This analysis evaluates the potential budget impact of adding ESK to formulary from the perspective of a health plan in the United States.

Methods: For a hypothetical health plan of 1 million members, the treatment-eligible population was estimated to be < 0.5% for each year. In the market scenario with esketamine, the market uptakes over the first three years were assumed as 1%, 3%, and 5%, respectively. Costs included drug acquisition, monitoring, and other medical resource use. The base-case scenario represented treatment consistent with ESK and real-world usual care; scenario analyses were tested for varying assumptions regarding healthcare utilization measures, such as length of stay and readmissions. Results: The total annual budget impact ranged from $500,000 in year 1 to less than $2 million by year 3. This corresponds to an impact of < $0.05, < $0.10, and < $0.15 per member per month over the three years, respectively.

Conclusion: Esketamine nasal spray was estimated to have a manageable impact on the annual budget of a commercial health plan in the United States.