Esketamine in Europe: eligible patients vs actually treated (the access gap, lower-bound tracker)
250patients in Poland's fully funded esketamine programme per Dec 2024 reporting, against an NFZ planning estimate of ~1,000 a year
Europe approves and funds esketamine, yet almost no country publishes how many people are actually treated. This dataset tracks the question country by country, and where a system published BOTH sides (its own eligibility estimate and a treated or capacity figure) it shows the gap: in the Netherlands roughly 8x, in Poland roughly 4x, in Scotland 27x by the submitting company’s own model. Payers ration by capacity and contracting, not by price. Where no figure is published we say so instead of estimating; it is a lower-bound tracker with documented gaps, not a market model.
Open row-level CSV of the gap table (eligible vs treated with per-row sources and dates), CC BY 4.0.
Poland: the one public natural experiment (full funding, counted outcomes)
What
Figure
As of
Source
NFZ planning estimate for programme B.147
~1,000 patients/year
cited 23 Dec 2024
NFZ estimate as reported by rynekzdrowia.pl
Patients in the programme
250
23 Dec 2024
rynekzdrowia.pl, citing Prof. Piotr Galecki, national consultant in psychiatry
Patients who had used the programme to date
156
11 Mar 2025
mzdrowie.pl; published later yet LOWER than the Dec 2024 figure, so the two sources count differently; neither is an official NFZ statistic
Contracted treatment points (live)
123
2026-10 (NFZ API)
our Poland B.147 dataset, refreshed monthly
Estimated treatment-resistant population (PL)
~300,000-450,000
expert estimates
termedia.pl / rp.pl
The access gap where both sides are published: eligible patients vs treated (verified primary sources)
Country
Eligible (system's own estimate)
Treated / capacity
Gap
Sources
Netherlands
1,500-2,000 per year (Zorginstituut estimate, cited in the joint NVvP / Depressie Vereniging / de Nederlandse ggz letter to the minister, 27 Oct 2022)
'a few dozen' patients started in 2022; 13 contracted providers as of Oct 2022 with an expected maximum capacity of 250 patients/year (the letter's own footnote); ~33 ENC-NL institutions by Oct 2026
~8x (eligible vs contracted capacity, 2022)
NVvP letter 27.10.2022 (PDF read in full, 2026-10-22); enc-nl.nl
Poland
~1,000 per year (NFZ planning estimate for B.147)
250 in the programme (Dec 2024 reporting); 156 'had used it' (Mar 2025 reporting); 123 contracted points live
~4x (vs Dec 2024 reporting)
rynekzdrowia.pl 23.12.2024; mzdrowie.pl 11.03.2025; NFZ API
Scotland
4,448 eligible in year 1, 4,497 in year 5 (submitting company's estimate in SMC2258)
165 treated in year 1 rising to 582 in year 5, same model
~27x in year 1, by the model's own design
SMC2258 detailed advice (PDF read in full, 2026-10-22)
Denmark
40-60 candidate patients per year (Medicinradet's own estimate, Nov 2025)
delivery through regional hospital psychiatry; capacity building since 19 Nov 2025
n/a (door opened Nov 2025)
medicinraadet.dk recommendation 19.11.2025
Belgium
no published eligibility estimate
~75 treatment centres (cited as a benchmark in the Dutch NVvP letter, 2022)
n/a
NVvP letter 27.10.2022
Germany: the largest funded market publishes no treated-patient count
What
Figure
As of
Source
GKV patients eligible under the label (target population)
316,561-505,315
2023 benefit reassessment
G-BA resolution D-930 (IQWiG calls the lower bound 'largely plausible')
Patients actually treated
no published figure found
checked 2026-10-20
we searched GKV/BfArM/G-BA channels and press and found no public per-drug treated-patient count; the Arzneiverordnungs-Report (paywalled) may contain prescription volumes, and we invite anyone with the figure to cite it to us
Share of esketamine prescriptions on private prescription
50%
2021-2024
BfArM, 96th routine session per Sec. 63 AMG (25 Mar 2025); BfArM itself calls the background unclear
Certified Spravato centres in our directory
47
2026-09-04
PsyAccess verified-provider dataset
Norway and the ceiling: what else is known
What
Figure
As of
Source
Norway: patients treated since the 2025 public introduction
no published figure found
checked 2026-10-20
registry follow-up is not public; a full HTA (metodevurdering) was commissioned 2026-04-27, decision review due by end-2028
Global Spravato sales, J&J full-year 2025
USD 1,696m (+57% y/y)
FY2025 results
J&J reporting as covered by biospace.com / healingmaps.com; predominantly US revenue, so a ceiling-context figure for Europe, not a European count
Methodology
Scope: funded, label-compliant esketamine treatment (plus psilocybin programmes where they exist); private off-label ketamine volumes are out of scope because no register counts them anywhere.
Every figure is transcribed as stated, with its source and its own date; figures from different sources use different counting methods and must not be read as a time series.
Where a country publishes no number, the row says 'not published' with the date we last checked. We do not interpolate, model or estimate missing values: the documented gap is itself the finding.
Poland is the only European country where a fully funded programme's uptake can be contrasted with its planning estimate from public statements; the gap (123 contracted points, roughly 150-250 patients depending on source and date, ~1,000 planned) is attributed by the quoted experts to the programme's entry criteria.
Germany's eligibility denominator (316,561-505,315 GKV patients) is the pharmaceutical company's dossier figure adopted in the G-BA resolution, assessed by IQWiG; it measures who qualifies under the label, not who is treated.
Eligible figures are the systems' own: an HTA body's or payer's estimate (Zorginstituut, SMC submission, Medicinradet) or the programme's planning estimate (NFZ); we never model eligibility ourselves. Gap ratios are computed only where both sides exist and are labelled with their dates; empty is empty, not zero.
A 2,800-patient eligibility figure for Norway circulates from HTA documents; we could not verify it in the public versions (checked 2026-10-22), so it is not in the table; the DMP reassessment file (sak 070-25) is the document a confirmation would come from.
Next additions: Norway (direct requests to the health trusts are the only route to a treated figure), Switzerland (BAG programme statistics exist for PAT: 723 patients in 2024), France/Italy/Spain (no public estimates found), and any country that publishes programme-level statistics.
PsyAccess (2026). Esketamine in Europe: eligible patients vs actually treated (the access gap, lower-bound tracker). https://psyaccess.health/data/treatment-volumes-europe/ (updated 2026-10-22). Licensed CC BY 4.0.
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<p>250 patients in Poland's fully funded esketamine programme per Dec 2024 reporting, against an NFZ planning estimate of ~1,000 a year. Source: <a href="https://psyaccess.health/data/treatment-volumes-europe/">PsyAccess: Esketamine in Europe: eligible patients vs actually treated (the access gap, lower-bound tracker)</a> (CC BY 4.0, updated 2026-10-22).</p>
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