J&J’s Spravato for depression ‘should be much cheaper’

Johnson & Johnson has priced its new Spravato nasal spray for treatment-resistant depression (TRD) too high to offer value for money, says a US cost-effectiveness body. The Institute for Clinical and Economic Review (ICER) has published its final report on Spravato (esketamine) and says the drug would need to be between 25% and 52% cheaper to meet its value threshold. The spray – which was approved by the FDA in March – has a wholesale acquisition cost of $295 per 28 mg device and costs around $32,400 for a year’s treatment, says ICER. To deliver fair value that price would have to come down to between $17,700 and $25,200 per year. The watchdog reviewed the clinical evidence for the drug and agreed that it is an effective add-on therapy for people who can’t derive enough benefit from standard oral antidepressant therapy, an assessment that will be welcomed by J&J given two of the five large trials used to support the drug’s filing failed to reach their efficacy endpoints. However, it said there wasn’t enough evidence to show it was better than ketamine, the generic drug from which it is derived, as well as other approaches to TRD such as “transcranial magnetic stimulation, electroconvulsive therapy, or augmentation with olanzapine.” There also isn’t enough long-term data with Spravato yet to show that its benefits are long-lasting, says ICER, although it acknowledges that the drug is intended as a fast-acting rescue medication for people at real risk of suicide or self-harm.