Impact of social determinants of health on esketamine nasal spray initiation among patients with treatment-resistant depression in the United States.

IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Kristin Clemens, Maryia Zhdanava, Amanda Teeple, Arthur Voegel, Kruti Joshi, Aditi Shah, Cindy Chen, Dominic Pilon
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引用次数: 0

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, P < 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, P < 0.001; Medicaid: HR = 0.68, P = 0.088), whereas racial or ethnic minorities had similar chances of initiation to White patients (Commercial-MA: HR = 1.23, P = 0.104; Medicaid: HR = 0.79, P = 0.376).

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

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来源期刊
Journal of managed care & specialty pharmacy
Journal of managed care & specialty pharmacy Health Professions-Pharmacy
CiteScore
3.50
自引率
4.80%
发文量
131
期刊介绍: JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.
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