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The decision by the UK National Institute for Health and Care Excellence not to recommend esketamine nasal spray for treatment resistant depression was unfair because its appraisal did not explain fully how the uncertainties in the evidence were taken into account in the decision making, an independent appeal panel has ruled. 1

NICE draft guidance published in January 2020 did not recommend esketamine for treatment resistant depression and said that the drug should not be made available on the NHS because of uncertainties over its clinical efficacy and cost effectiveness. 2 3 After two consultations, NICE maintained its view in the final appraisal document published in May this year. 4

In June esketamine’s manufacturer, Janssen, and the Royal College of Psychiatrists appealed the decision, arguing that NICE had acted unfairly and exceeded its powers in not recommending the treatment and that the decision was unreasonable in light of the evidence submitted. …