Johnson & Johnson insists its nasal spray antidepressant Spravato can reduce the cost of caring for treatment-resistant depression (TRD) compared to oral drugs, in a riposte to critics who say it is too expensive.
The drugmaker has reported a new analysis which suggests that adding Spravato (esketamine) to background oral therapy cost at least $20,000 less per patient in those achieving remission than patients taking an oral antidepressant plus placebo, with the gain three-fold higher if loss of productivity was taken into account.
The study follows a damning report from the Institute for Clinical and Economic Review (ICER) in the US two weeks ago, which concluded that Spravato – while “promising in terms of clinical efficacy for symptoms improvement and achieving clinical response compared to placebo” – was overpriced.
ICER’s modelling suggests that at the base-case price of $295 per 28mg intranasal device, Spravato costs around $198,000 per quality-adjusted life year (QALY) gained, above its usual $150,000 threshold, and says that level was breached “even after inclusion of productivity gains from improved mood.”
Spravato was hailed as an end to a drought in new-mechanism antidepressants when it was approved by the FDA in March, and a lifeline for patients with TRD who had seen no improvement in mood despite trying multiple oral antidepressants.
Esketamine is a glutamate NMDA receptor modulator, and is of particular interest to clinicians because it starts to work much more quickly than current antidepressants.
It is a single isomer form of ketamine, a low-cost anaesthetic, and ICER says the similarity between the two drugs “raises issues for all stakeholders about how to consider off-label prescription and coverage of a treatment that has not been as well studied but is being increasingly used for TRD.”
For its part, J&J insists its new cost-per-remitter analysis is a valid measure of Spravato’s benefits.
“We found that, because it can help more patients have a significant reduction in their depressive symptoms compared to an oral antidepressant plus placebo, Spravato is a meaningful clinical and economic investment,” said John Sheehan, director of real-world value and evidence at J&J’s Janssen Scientific Affairs unit.
“People who no longer experience ongoing depressive symptoms pay less to manage their disease, reduce the cost to the overall healthcare system, and are able to get back to their lives,” he added.
Competition to Spravato is starting to make its way through trials. One rival, Singapore biotech iX Biopharma, revealed this week that its sublingual formulation of ketamine – Wafermine – has shown efficacy in a phase 2b trial in moderate to severe acute pain. It’s also poised to start phase 2 testing in TRD.