(343) Cost Effectiveness of Zuranolone for Treatment of Postpartum Depression

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Ryan Duggal, MD (he/him/his)

Staff Physician
Indian Health Service, Pine Ridge Hospital
Salt Lake City, UT, United States

Coauthor(s)

CT

Casey Tak, PhD

University of Utah
Salt Lake City, Utah, United States
Marcela C. Smid, MA, MD, MS (she/her/hers)

Associate Professor of Obstetrics and Gynecology
University of Utah Health
Salt Lake City, Utah, United States

Objective: Zuranolone is a novel GABA-A agonist approved to treat postpartum depression (PPD), however its cost effectiveness (CE) is unknown. We sought to estimate the CE of Zuranolone for PPD treatment when compared to selective serotonin receptor inhibitors (SSRIs).

Study Design: We constructed a decision-analytic model to estimate the CE of treating postpartum depression with Zuranolone as compared to SSRIs and placebo over one year among a cohort of 10,000 postpartum individuals with depression from a perspective of a third-party payer. The direct medical costs of PPD and medication-related costs over one year were gathered from existing literature and incorporated into the model. We defined effectiveness in two ways: treatment response defined as >50% decrease in symptoms from baseline and remission of PPD. Using first order Monte Carlo simulations, we calculated the incremental cost-effectiveness ratio (ICER). We also explored parameter uncertainty with probabilistic sensitivity analyses.

Results: Across the hypothetical cohort, SSRIs returned the lowest average cost for both effectiveness outcomes (response: $18880; remission: $18876) across the three strategies. The proportion of the cohort experiencing treatment response and remission in the SSRI group were 0.33 and 0.15, respectively. Zuranolone showed the highest average cost across both outcomes (response: $33986; remission: $15085) but also yielded the highest effectiveness (response: 0.72; remission: 0.37). The ICER of Zuranolone compared to SSRIs was $105635 for treatment response and $271799 for remission. The probabilistic sensitivity analysis showed that Zuranolone was the preferred strategy at willingness-to-pay thresholds at or above approximately $105000 for treatment response whereas SSRIs were the preferred strategy across all explored thresholds.

Conclusion: Zuranolone is cost effective for treatment response of PPD when compared to SSRIs, however it is not cost effective at the given thresholds for full remission