The National Institute for Health and Care Excellence (NICE), which
determines if a drug is included in Britain’s National Healthcare System
(NHS), said there was a lack of evidence on how the treatment,
chemically called esketamine, fared over rivals, and that it could raise
costs.
In the draft guidance, NICE also questioned the effects of stopping
the treatment, saying it was unclear if any improvement in symptoms
would be maintained after a course, potentially adding to costs.
“Introduction of esketamine into clinical practice in the NHS will be
complex because the structure and delivery of services would need to be
changed,” said Meindert Boysen, director of the centre for health
technology evaluation at NICE.
NHS currently manages treatment-resistant depression with oral
medicines, followed by a second drug if symptoms do not improve.
Sometimes the state-run health service combines drugs with psychological
therapy.
Esketamine is approved as a combination therapy for adults with major
depressive disorder who have not benefited from prior treatments.
It is chemically a mirror image of the anaesthetic ketamine that is
often abused under the street name “Special K”, and hence requires that
it be given under the supervision of a healthcare professional in a
clinic.
“Estimates of the costs of providing the clinical service for
esketamine were highly uncertain, as are the costs of repeated courses
of the drug,” Boysen said.
In the United States, the spray is priced
here at $590 for a 56 mg dose and $885 for 84 mg.
Esketamine received approvals from European and U.S. regulators last
year, marking a new type of antidepressant in over 30 years and raising
hopes for its relatively fast action to treat patients failed by prior
treatments.
More than 264 million people of all ages suffer from depression worldwide, according
here to the World Health Organization.
https://www.reuters.com/article/us-johnson-johnson-spravato-britain/uk-healthcare-cost-agency-rejects-jjs-nasal-spray-for-depression-idUSKBN1ZR017