BACKGROUND: Zuranolone, the first oral treatment for postpartum depression (PPD), was approved for adults by the Food and Drug Administration in August 2023. Previously, selective serotonin reuptake inhibitors (SSRIs) were first-line medications recommended for PPD treatment. SSRIs require ≥6 weeks to demonstrate an effect, while zuranolone has a 14-day treatment course.
OBJECTIVE: To estimate the nonpharmacy direct medical costs and healthcare resource use (HCRU) with zuranolone relative to SSRIs in the treatment of PPD in United States (US) adults.
METHODS: A 1-year cost offset analysis was developed in Excel for a cohort of US adults with incident PPD treated with either zuranolone or a basket of SSRIs (i.e., sertraline, paroxetine, fluoxetine). Nonpharmacy direct medical costs for adults with PPD and their child were estimated, including costs for screening, diagnosis, treatment-related adverse events, and the adult’s and child’s PPD-related HCRU. Drug acquisition costs were excluded. HCRU included inpatient admissions and visits to general practitioners, specialists for diagnosis and treatment, and emergency departments. Costs were inflated to 2023 US dollars and not discounted. Input values for costs, clinical effectiveness, HCRU, adverse events, and PPD-related mortality were obtained from published US sources. Outcomes included total and per-person nonpharmacy direct medical costs, HCRU, and mortality.
RESULTS: For the 2022 US adult birth cohort (3,630,511 live births), an estimated 479,227 patients had incident PPD symptoms (13.2%); of those, 133,704 were diagnosed with PPD (27.9%); and of those, 75,543 were treated (56.5%). Among the treated cohort, zuranolone use was associated with $165.5 million in nonpharmacy direct medical costs compared with $174.0 million if the cohort was treated with SSRIs (+$8.5 million). Relative to SSRIs, zuranolone treatment was associated with reduced HCRU: −1,686 outpatient visits, −246 inpatient days, −1,172,662 adverse event–related visits, and −158 emergency department visits. Zuranolone treatment also reduced projected deaths by 0.09 relative to SSRIs. Overall, nonpharmacy direct medical costs per treated adult were $2,190 with zuranolone and $2,303 with SSRIs (+$113) including the child’s first-year HCRU or $1,882 with zuranolone and $1,994 with SSRIs (+$112) if excluded.
CONCLUSIONS: Treatment with zuranolone is projected to reduce nonpharmacy direct costs, lead to fewer PPD-associated deaths, and reduce HCRU for adults with PPD relative to SSRIs.