NICE Rejects Janssen’s Spravato Nasal Spray, Questioning Benefit and Cost-Effectiveness

The UK’s National Institute for Health and Care Excellence (NICE) decided not to recommend Janssen’s nasal spray Spravato (esketamine) for treatment-resistant depression due to uncertainty about its clinical and cost-effectiveness.

NICE said it is unclear how much benefit Spravato with an oral antidepressant provides over oral antidepressants with antipsychotics or lithium adjunctive therapy, oral antidepressants combined, or other alternative treatments because they haven’t been compared directly.

The institute also flagged uncertainties about stopping Spravato, specifically if improvements in symptoms will be maintained after a course of treatment. Because of this, the costs of repeated courses of treatment are unknown, the agency said.