Healthcare resource utilization and costs associated with postpartum depression among commercially insured households

Abstract

Objective: To quantify the economic burden of postpartum depression (PPD) that accrues to commercially insured households in the year following childbirth. Methods: Administrative claims data from OptumHealth Care Solutions (2009-2016) were used to identify households that included women identified with PPD per the algorithm and propensity score-matched comparison households of women who were not identified with PPD or a history of depression after childbirth. Study outcomes included direct total all-cause medical and pharmaceutical costs during the first year following childbirth and number of outpatient visits at the household level stratified by household member. Results: Households affected by PPD as identified by the algorithm (N ¼ 7769) incurred 22% higher mean total all-cause medical and pharmaceutical spending than unaffected matched controls (N ¼ 41,308) during the first year following childbirth ($36,049 versus $29,448, p < 0.01) and an average of 16 more outpatient visits than unaffected households (p < .01). Costs accrued by mothers comprised the largest share (>50%) of total all-cause spending. Mothers identified with PPD had significantly higher annual mean direct total all-cause medical and pharmaceutical spending than their matched controls without PPD ($19,611 versus $15,410, p < .01), driven primarily by an average of 11 more outpatient visits than unaffected mothers (p < .01). Conclusions: Households affected by PPD as identified by the algorithm incurred higher mean total all-cause medical and pharmaceutical spending during the first year following childbirth than did their matched controls identified without PPD, but not all costs were attributable to maternal treatment for PPD. These findings contribute to a better understanding of the potential economic burden associated with PPD and demonstrated costs may extend beyond the mother to members of the household.

The Current State of Donor Human Milk Use and Practice

“…They self‐reported that the use of donor human milk reduced symptoms of postpartum depression and anxiety and provided psychological comfort that formula could not 42 . This indicates a possibility of further savings in health care cost given that medical and pharmaceutical spending incurred households with women diagnosed with postpartum depression is 22% higher than those with women without depression 43 . Considering that this was a small‐scale study and the benefit was limited to donor human milk recipients, more evidence is needed to verify the cost‐saving potential through larger scale quantitative and comparison studies.…”

“…42 This indicates a possibility of further savings in health care cost given that medical and pharmaceutical spending incurred households with women diagnosed with postpartum depression is 22% higher than those with women without depression. 43 Considering that this was a small-scale study and the benefit was limited to donor human milk recipients, more evidence is needed to verify the cost-saving potential through larger scale quantitative and comparison studies. Nevertheless, the use of donor human milk may salvage breastfeeding relationships that eventually lead to motivation to continue lactation efforts.…”

Allopregnanolone Concentrations in Breast Milk and Plasma from Healthy Volunteers Receiving Brexanolone Injection, With Population Pharmacokinetic Modeling of Potential Relative Infant Dose

“…Using parameters from the model, the RID was low (maximum value, 1.3%), suggesting a low risk to breastfed infants. PPD is associated with multiple negative consequences for mothers and children [8,[33][34][35], and standard-of-care antidepressants are among the most frequently prescribed medications during the postpartum period [26]. Previous reports have shown that patients with severe PPD who received brexanolone infusion showed a significant and rapid reduction in their 17-item Hamilton Rating Scale for Depression total score compared with placebo, with a durable response [14,15,21].…”

Comparison of Estimated Incentives for Preventing Postpartum Depression in Value-Based Payment Models Using the Net Present Value of Care vs Total Cost of Care

“…The model included monthly health care costs for individuals and their children, which were higher when the individual was depressed, based on costs reported in the cost-effectiveness study that provided the conceptual foundation for the present model and other literature specific to the Medicaid population. 16 , 34 , 35 , 36 , 37 , 38 , 39 While PPD also causes spillovers into increased health care costs for other household members, including partners and other children, we did not include those costs here, nor productivity benefits. We calculated intervention costs when provided as individual counseling (mean [SD], $761.94 [$225.66] per person), group-based counseling (mean [SD], $137.74 [$40.80] per person), and the additional costs of antenatal screening ($2.27) when relevant, based on the Medicaid fee schedule from a representative state and based on a distribution of expected sessions attended, drawn from the meta-analysis of the preventive interventions.…”