Mental-Health Related Disability Leave and Costs Among Patients with Treatment Resistant Depression Initiated on Esketamine and Conventional Therapies
Bibliographic record
Abstract
Introduction Treatment resistant depression (TRD) is linked to disproportionate unemployment and productivity burden in the US. Little is known about mental-health (MH)-related disability leave and costs of patients with TRD initiated on esketamine (ESK) versus conventional therapies including transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), or antipsychotic augmentation (AP) in the US. Methods Adults with evidence of TRD (≥2 unique antidepressants of adequate dose and duration within the same major depressive episode) were selected from Merative™ MarketScan® Commercial and Medicare Supplemental databases (01/2016-01/2023) and classified in four cohorts (ESK, ECT, TMS, and AP) based on therapy initiated (index date) on/after 03/05/2019 (ESK approval date for TRD). Patients had ≥12 months of health plan eligibility pre-index date and disability information available pre-and post-index in the Merative™ MarketScan® Health and Productivity Management database (01/2016-12/2021). MH-related disability days (i.e., short- or long-term) and associated costs (USD 2022) were reported per-patient-per-month (PPPM) for the 6 months pre- and post-index. Results The ESK cohort included 107 patients (mean age=45.5 years; female=54.2%), ECT cohort included 55 patients (mean age=47.6 years; female=41.8%), TMS cohort included 443 patients (mean age=46.1 years; female=57.3%) and AP cohort included 4,374 patients (mean age=44.8 years; female=59.1%). At month 6 pre-index, ESK cohort had a mean of 1.7 MH-related disability days PPPM relative to 1.2 days in the TMS, 1.3 days in the ECT, and 0.8 days in the AP cohort while mean MH-related disability costs were $443 PPPM in the ESK cohort relative to $178 in the ECT, $339 in the TMS, and $143 in the AP cohort. In all cohorts, mean MH-related disability days and costs peaked at month 1 after therapy initiation followed by a decreasing trend. At month 6 post-index versus month 6 pre-index, the mean number of MH-related disability days decreased by 0.4 days PPPM in the ESK cohort, remained the same in the TMS cohort, and increased by 1.6 and 0.1 days in the ECT and AP cohorts, respectively. In the same timeframe, MH-related disability costs decreased by $312 and $123 PPPM in the ESK and TMS cohorts and increased by $353 and $26 in the ECT and AP cohorts, respectively. MH-related disability days and costs were driven primarily by short-term disability. Conclusion In this descriptive analysis, mean MH-related disability days and costs trended higher at month 6 before therapy initiation in ESK relative to TMS, ECT, and AP cohorts. ESK initiation was associated with lower mean MH-related disability days and costs at month 6 after versus before initiation. This trend was either not observed or less pronounced among patients with TRD initiated on conventional therapies. Results suggest potential economic and societal gains associated with ESK treatment for TRD. Funding Janssen Scientific Affairs, LLC
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".