(Reuters) – Britain’s healthcare cost agency on Tuesday recommended against including Johnson & Johnson’s nasal spray for depression, Spravato, in the country’s healthcare network, citing uncertainties over its clinical and cost effectiveness.

The National Institute for Health and Care Excellence (NICE), which determines if a drug is included in Britain’s National Healthcare System (NHS), said there was a lack of evidence on how the treatment, chemically called esketamine, fared over rivals, and that it could raise costs.

In the draft guidance, NICE also questioned the effects of stopping the treatment, saying it was unclear if any improvement in symptoms would be maintained after a course, potentially adding to costs.

“Introduction of esketamine into clinical practice in the NHS will be complex because the structure and delivery of services would need to be changed,” said Meindert Boysen, director of the centre for health technology evaluation at NICE.

NHS currently manages treatment-resistant depression with oral medicines, followed by a second drug if symptoms do not improve. Sometimes the state-run health service combines drugs with psychological therapy.

Esketamine is approved as a combination therapy for adults with major depressive disorder who have not benefited from prior treatments.

It is chemically a mirror image of the anaesthetic ketamine that is often abused under the street name “Special K”, and hence requires that it be given under the supervision of a healthcare professional in a clinic.

“Estimates of the costs of providing the clinical service for esketamine were highly uncertain, as are the costs of repeated courses of the drug,” Boysen said.

In the United States, the spray is priced https://in.reuters.com/article/johnson-johnson-fda-pricing/jj-prices-ketamine-like-depression-treatment-at-590-885-for-two-doses-idINKCN1QN2C6 at $590 for a 56 mg dose and $885 for 84 mg.

Esketamine received approvals from European and U.S. regulators last year, marking a new type of antidepressant in over 30 years and raising hopes for its relatively fast action to treat patients failed by prior treatments.

More than 264 million people of all ages suffer from depression worldwide, according https://www.who.int/news-room/fact-sheets/detail/depression to the World Health Organization.

(Reporting by Pushkala Aripaka in Bengaluru; Editing by Shinjini Ganguli)