CADTH undertook reanalyses when possible to address limitations, including the use of unadjusted response and remission rates for the comparator (oral antidepressant), removing discontinuation rates for recovery for esketamine plus oral antidepressant treatment, and removing all-cause population mortality.
Based on the CADTH reanalyses for adult patients with major depressive disorder (MDD) who had an inadequate response to at least 2 prior antidepressant therapies, the incremental cost-effectiveness ratio (ICER) for esketamine plus oral antidepressant is $125,376 per quality-adjusted life-year (QALY), which would not be considered a cost-effective treatment at a willingness-to-pay (WTP) threshold of $50,000 per QALY. There is a 1% likelihood that esketamine plus oral antidepressant would fall below $50,000 per QALY and a 31% likelihood at a $100,000 per QALY threshold. Price reductions can improve the cost-effectiveness of esketamine plus oral antidepressant in patients with treatment-resistant MDD. At a WTP threshold of $50,000 per QALY, a price reduction of approximately 60% is required for esketamine plus oral antidepressant to be considered cost-effective.
CADTH was unable to address the impact of treatment effect waning or the impact of partial responders. Further, due to a lack of clinical data, CADTH was unable to implement comparisons with other relevant comparators including IV ketamine or adjunctive treatments. The CADTH clinical review team was unable to make conclusions regarding the effect of esketamine on health-related quality of life (QoL), suicidality, hospitalization, or emergency department visits, as the trials were not designed or powered to evaluate these outcomes. It was also noted that long-term safety of esketamine is uncertain
Version: Final (with redactions)
Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
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About CADTH: CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs, medical devices, diagnostics, and procedures in our health care system.
