Impact of Social Determinants of Health on Esketamine Nasal Spray Initiation Among Patients with Treatment-resistant Depression in the United States

Overview

Journal J Manag Care Spec Pharm

Specialties Pharmacology
Pharmacy

Date 2024 Dec 20

PMID 39704732

Authors

Kristin Clemens

Maryia Zhdanava

Amanda Teeple

Arthur Voegel

Kruti Joshi

Aditi Shah

Cindy Chen

Dominic Pilon

Affiliations

Soon will be listed here.

Abstract

Background: Disparities in mental health care access and health outcomes based on sociodemographic factors in the United States have been extensively documented. However, there is limited knowledge regarding these socioeconomic factors with respect to initiation of esketamine nasal spray, a novel therapy for treatment-resistant depression (TRD).

Objective: To evaluate the association of socioeconomic factors with the initiation of esketamine nasal spray.

Methods: Adults with TRD and commercial or Medicare Advantage (MA) insurance (Commercial-MA cohort) were included from Optum's deidentified Clinformatics Data Mart Database (January 2016-June 2022) and adults with Medicaid insurance (Medicaid cohort) were included from Merative MarketScan Multi-State Medicaid Database (January 2016-June 2022). The baseline period spanned 12 months before the index date (latter of evidence of TRD or US esketamine approval date); follow-up period spanned the index date until the end of health plan eligibility/data availability. Multivariate Cox proportional hazard models were used, separately for each cohort, to evaluate the association of characteristics with time to esketamine initiation; patients who did not initiate esketamine were censored at the end of follow-up.

Results: In the Commercial-MA cohort, 201,937 patients were included (75.0% female, mean age 62.3 years, 80.9% White, 82.8% having less than a bachelor's degree, 60.3% with a household income less than $75,000). Having both an education of less than a bachelor's degree and a household income less than $75,000 reduced the chance of esketamine initiation by 37% (hazard ratio [HR] = 0.63, < 0.001). In the Medicaid cohort, 51,206 patients were included (77.8% female, mean age 43.2 years, 78.6% White). In both cohorts, chances of initiation trended to be lower in females (Commercial-MA: HR = 0.63, < 0.001; Medicaid: HR = 0.68, = 0.088), whereas racial or ethnic minorities had similar chances of initiation to White patients (Commercial-MA: HR = 1.23, = 0.104; Medicaid: HR = 0.79, = 0.376).

Conclusions: Disparities in esketamine nasal spray initiation were observed based on education, income, and gender highlighting a potential health equity gap.

References

Brendle M, Ahuja S, Valle M, Moore C, Thielking P, Malone D . Safety and effectiveness of intranasal esketamine for treatment-resistant depression: a real-world retrospective study. J Comp Eff Res. 2022; 11(18):1323-1336. DOI: 10.2217/cer-2022-0149. View

Driscoll A, Bernstein A . Health and access to care among employed and unemployed adults: United States, 2009-2010. NCHS Data Brief. 2012; (83):1-8. View

Daly E, Trivedi M, Janik A, Li H, Zhang Y, Li X . Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry. 2019; 76(9):893-903. PMC: 6551577. DOI: 10.1001/jamapsychiatry.2019.1189. View

Le Cook B, Trinh N, Li Z, Shu-Yeu Hou S, Progovac A . Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004-2012. Psychiatr Serv. 2016; 68(1):9-16. PMC: 5895177. DOI: 10.1176/appi.ps.201500453. View

Syed S, Gerber B, Sharp L . Traveling towards disease: transportation barriers to health care access. J Community Health. 2013; 38(5):976-93. PMC: 4265215. DOI: 10.1007/s10900-013-9681-1. View

Wajs E, Aluisio L, Holder R, Daly E, Lane R, Lim P . Esketamine Nasal Spray Plus Oral Antidepressant in Patients With Treatment-Resistant Depression: Assessment of Long-Term Safety in a Phase 3, Open-Label Study (SUSTAIN-2). J Clin Psychiatry. 2020; 81(3). DOI: 10.4088/JCP.19m12891. View

Chen X, Hou X, Bai D, Lane R, Zhang C, Canuso C . Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Plus a Newly Initiated Oral Antidepressant in Adult Patients with Treatment-Resistant Depression: A Randomized, Double-Blind, Multicenter, Active-Controlled Study Conducted in China and USA. Neuropsychiatr Dis Treat. 2023; 19:693-707. PMC: 10072270. DOI: 10.2147/NDT.S391096. View

McIntyre R, Alsuwaidan M, Baune B, Berk M, Demyttenaere K, Goldberg J . Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry. 2023; 22(3):394-412. PMC: 10503923. DOI: 10.1002/wps.21120. View

Sommers B, McMurtry C, Blendon R, Benson J, Sayde J . Beyond Health Insurance: Remaining Disparities in US Health Care in the Post-ACA Era. Milbank Q. 2017; 95(1):43-69. PMC: 5339398. DOI: 10.1111/1468-0009.12245. View

10.

Joshi K, Pilon D, Shah A, Holiday C, Karkare S, Zhdanava M . Treatment patterns, healthcare utilization, and costs of patients with treatment-resistant depression initiated on esketamine intranasal spray and covered by US commercial health plans. J Med Econ. 2023; 26(1):422-429. DOI: 10.1080/13696998.2023.2188845. View

11.

Teeple A, Zhdanava M, Pilon D, Caron-Lapointe G, Lefebvre P, Joshi K . Access and real-world use patterns of esketamine nasal spray among patients with treatment-resistant depression covered by private or public insurance. Curr Med Res Opin. 2023; 39(8):1167-1174. DOI: 10.1080/03007995.2023.2239045. View

12.

Lubloy A . Factors affecting the uptake of new medicines: a systematic literature review. BMC Health Serv Res. 2014; 14:469. PMC: 4283087. DOI: 10.1186/1472-6963-14-469. View

13.

Schiff G, Galanter W, Duhig J, Lodolce A, Koronkowski M, Lambert B . Principles of conservative prescribing. Arch Intern Med. 2011; 171(16):1433-40. DOI: 10.1001/archinternmed.2011.256. View

14.

Kim J, Farchione T, Potter A, Chen Q, Temple R . Esketamine for Treatment-Resistant Depression - First FDA-Approved Antidepressant in a New Class. N Engl J Med. 2019; 381(1):1-4. DOI: 10.1056/NEJMp1903305. View

15.

Ochs-Ross R, Daly E, Zhang Y, Lane R, Lim P, Morrison R . Efficacy and Safety of Esketamine Nasal Spray Plus an Oral Antidepressant in Elderly Patients With Treatment-Resistant Depression-TRANSFORM-3. Am J Geriatr Psychiatry. 2019; 28(2):121-141. DOI: 10.1016/j.jagp.2019.10.008. View

16.

Zaki N, Chen L, Lane R, Doherty T, Drevets W, Morrison R . Long-term safety and maintenance of response with esketamine nasal spray in participants with treatment-resistant depression: interim results of the SUSTAIN-3 study. Neuropsychopharmacology. 2023; 48(8):1225-1233. PMC: 10267177. DOI: 10.1038/s41386-023-01577-5. View

17.

. Life expectancy by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. Lancet. 2022; 400(10345):25-38. PMC: 9256789. DOI: 10.1016/S0140-6736(22)00876-5. View

18.

Braveman P . Health inequalities by class and race in the US: what can we learn from the patterns?. Soc Sci Med. 2012; 74(5):665-7. DOI: 10.1016/j.socscimed.2011.12.009. View

19.

Liberman J, Pesa J, Rui P, Joshi K, Harding L . Social determinants and distance from certified treatment centers are associated with initiation of esketamine nasal spray among patients with challenging-to-treat major depressive disorder. Medicine (Baltimore). 2023; 102(7):e32895. PMC: 9935983. DOI: 10.1097/MD.0000000000032895. View

20.

Kullgren J, McLaughlin C, Mitra N, Armstrong K . Nonfinancial barriers and access to care for U.S. adults. Health Serv Res. 2011; 47(1 Pt 2):462-85. PMC: 3393009. DOI: 10.1111/j.1475-6773.2011.01308.x. View