Profiles of Medicaid Beneficiaries with Treatment-Resistant Depression Initiated on Esketamine Nasal Spray

While the literature on esketamine use in commercially insured patients with treatment-resistant depression (TRD) is growing, data on Medicaid beneficiaries remain limited. This study aimed to fill this gap by exploring characteristics of Medicaid beneficiaries with TRD who initiated esketamine treatment in the United States.

Adults with TRD initiating esketamine on/after 03/05/2019 (index date) were selected from the Merative™ MarketScan^® Multi-State Medicaid Database (01/2016-06/2022). Baseline was 12 months pre-index date; follow-up spanned from the index date until the end of health plan insurance or data. Patient baseline characteristics and follow-up treatment patterns, healthcare resource utilization (HRU), and medical costs were reported.

A total of 151 patients were identified (mean age: 40.6 years; female: 70.2%; racial minorities: 31.1%). The most common comorbidities were anxiety (81.5%), sleep-wake disorders (47.0%), trauma-related disorders (43.0%), substance-related disorders (30.5%), and obesity (30.5%). Patients completed a mean of 22.5 esketamine sessions; 67.5% of patients completed the induction phase (≥ 8 sessions), 62.3% initiated the maintenance phase, and 53.0% completed ≥ 12 sessions. After esketamine initiation, patients had a mean of 0.02 inpatient admissions, 0.09 inpatient days, 0.31 emergency department visits, and 5.85 outpatient visits monthly. The mean follow-up medical costs were $2075 monthly, including inpatient costs of $97, emergency department costs of $51, and outpatient costs of $1902.

Medicaid beneficiaries with TRD who initiated esketamine treatment had a high comorbidity burden and a higher proportion of racial minorities than the US population overall. Nonetheless, most patients progressed to maintenance phase of esketamine treatment. Findings suggest that esketamine may be a viable treatment option for this complex patient population.