KETAMINE NASAL SPRAY (SPRAVATO) IN THE UK: AVAILABILITY & COST

INTRODUCTION: A NEW FRONTIER IN DEPRESSION TREATMENT

Depression remains a significant mental health challenge in the UK, with many individuals not responding to traditional treatments. Spravato, the brand name for esketamine nasal spray, has emerged as a promising alternative for those with treatment-resistant depression (TRD). This article explores the availability, cost, and considerations surrounding Spravato in the UK.

UNDERSTANDING SPRAVATO: WHAT IS IT?

Spravato is a nasal spray formulation of esketamine, a derivative of ketamine. Unlike traditional antidepressants that primarily affect serotonin and norepinephrine, esketamine targets the glutamate system by antagonizing the N-methyl-D-aspartate (NMDA) receptor. This action is believed to enhance synaptic plasticity, promoting the formation of new neural connections, which may alleviate depressive symptoms rapidly.

AVAILABILITY OF SPRAVATO IN THE UK

NHS ACCESS

As of now, Spravato is not widely available through the NHS in England and Wales. The National Institute for Health and Care Excellence (NICE) has not recommended its routine use due to concerns about cost-effectiveness and uncertainties regarding long-term efficacy. However, in Scotland, the Scottish Medicines Consortium (SMC) has accepted Spravato for use within NHS Scotland for adults with TRD.

PRIVATE CLINICS

Several private clinics across the UK offer Spravato treatment for eligible patients. These clinics typically require a diagnosis of TRD and a prescription from a licensed psychiatrist. Some notable clinics include:

• Nightingale Hospital (London): The first private hospital in the UK to provide Spravato treatment.
• Save Minds Ketamine Clinic (London): Offers Spravato treatment under psychiatric supervision.
• Oxford Health NHS Foundation Trust: Provides Spravato on a self-pay basis as part of their Interventional Psychiatry Service.

COST OF SPRAVATO TREATMENT

The cost of Spravato treatment can vary depending on the dosage and the clinic. According to the British National Formulary, the list prices (excluding VAT) are:

• £163 for a 28 mg dose
• £326 for a 56 mg dose
• £489 for an 84 mg dose

At Oxford Health NHS Foundation Trust, the administration costs are:

• £551 for a 56 mg dose
• £714 for an 84 mg dose

It’s important to note that these costs may not include additional fees for psychiatric consultations and post-administration monitoring.

ELIGIBILITY CRITERIA FOR SPRAVATO

To be considered for Spravato treatment in the UK, patients typically must:

• Be diagnosed with treatment-resistant major depressive disorder.
• Have not responded to at least two different antidepressant treatments during the current depressive episode.
• Be currently taking an SSRI or SNRI.
• Be under the care of a licensed psychiatrist.

ADMINISTRATION AND MONITORING

SIDE EFFECTS AND SAFETY CONSIDERATIONS

Common side effects of Spravato include:

• Dissociation
• Dizziness
• Nausea
• Increased blood pressure

These effects are typically transient and resolve within a few hours.

Due to the potential for abuse and the need for monitoring, Spravato is classified as a controlled substance and is only administered in certified healthcare settings.

COMPARISON WITH OTHER TREATMENTS

While Spravato offers a novel mechanism of action and rapid onset of effect, its high cost and the need for supervised administration make it less accessible compared to other treatments. Alternative options include:

• Intravenous (IV) Ketamine: Often used off-label for TRD, IV ketamine is less expensive but requires infusion sessions.
• Oral Ketamine: Available in some clinics, oral ketamine is more affordable but may have variable absorption rates.
• Traditional Antidepressants: SSRIs and SNRIs remain first-line treatments but may not be effective for all patients.

Patients should consult with their healthcare provider to determine the most appropriate treatment option based on their specific needs and circumstances.

CONCLUSION: IS SPRAVATO RIGHT FOR YOU?

Spravato represents a significant advancement in the treatment of TRD, offering hope to patients who have not found relief with traditional therapies. However, its limited availability on the NHS and high cost in private clinics may pose challenges. Patients interested in Spravato should consult with a licensed psychiatrist to assess eligibility and discuss potential benefits and risks.