Original Title: Esketamina intranasal en depresión mayor severa resistente

Authors' recommendations: No studies comparing the use of intranasal esketamine versus electroconvulsive therapy in patients with treatment-resistant major depression disorder were found. Low-quality evidence suggests that esketamine in conjunction with oral antidepressants might not show clinically significant differences when compared to second generation antipsychotic drugs in combination with oral antidepressants. Low-quality evidence suggests that esketamine in conjunction with adjusted oral antidepressants would considerably improve depression symptoms up to 28 days, versus adding placebo to adjusted oral antidepressants. The efficacy evidence regarding the delay of relapse episodes after 16 weeks and longer, does not allow to draw conclusions in this regards. Evidence in relation to decreasing suicide-related symptoms does not allow to draw conclusions either. Esketamine was observed to be associated with a higher rate of dropouts due to intolerance when compared to placebo. All the studies against placebo mention that a limiting factor is the difficulty of preserving the blinding, given the dissociative symptoms associated to esketamine, in addition to other risks of bias which increase uncertainty. The Latin American public health sponsors surveyed do no mention or do not cover intranasal esketamine. The preliminary assessment carried out by the United Kingdom recommended not to include this technology since its efficacy is uncertain and it is not considered cost-effective. United States private health sponsors cover it. In Argentina, the Argentine Consensus on Treatment-Resistant Major Depression Disorder recommend the use of esketamine as one of the first treatment options. The foreign clinical practice guidelines analyzed, do not mention its use. The cost-effectiveness of intranasal esketamine for major depression disorder is unknown in Argentina; however, studies conducted in high-income countries (United States and United Kingdom) concluded that this technology was not cost-effective.

Project Status: Completed

Year Published: 2020

URL for published report: https://www.iecs.org.ar/home-ets/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)