J&J’s Spravato only slightly too expensive, Icer says

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Johnson & Johnson’s nasal spray antidepressant Spravato will probably be cost effective at the actual price paid by insurers, once rebates are taken into account. The US Institute for Clinical and Economic Review (Icer) has concluded that the drug’s list price, the starting point for payer negotiations, is only a little bit too high. In a draft report Icer said Spravato’s wholesale acquisition cost of $295 per 28mg device, when added to antidepressants, would yield a price per quality-adjusted life year of $198,000 compared with antidepressants alone. This is only slightly above the usual cost-effectiveness threshold of $150,000 per Qaly. Icer said Spravato’s price per dose would need to be cut to $220 to hit that mark, something that will likely happen as J&J seeks to gain access to formularies. The report included an unusual metric, the price per depression-free day; using that as a yardstick Spravato costs $330 per depression-free day.

Spravato: Close to cost-effectiveness
Cost per Qaly at WAC $198,000
Cost per depression-free day $330
Price per 28mg dose $295
Price per 28mg dose to get to $150,000/Qaly $220
Qaly: quality-adjusted life year WAC: wholesale acquisition cost. Source: Icer.

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