Healthcare utilization and costs associated with dextromethorphan-bupropion versus selected other branded treatments for major depressive disorder: a US real-world study.

AIMS: This study aimed to evaluate healthcare resource utilization (HCRU) and costs among adults with major depressive disorder (MDD) initiating dextromethorphan-bupropion (AUVELITY) versus cariprazine, brexpiprazole, or esketamine.

METHODS

Using Merative MarketScan Commercial and Medicare claims data (January 2021-March 2024), adults initiating dextromethorphan-bupropion or a selected branded comparator between January 2022 and March 2024 were identified and assigned to mutually exclusive treatment cohorts (index date = first prescription claim). Eligible patients had ≥ 1 pre-index MDD diagnosis and continuous medical and pharmacy enrollment for 6 months before and after index. Comparator cohorts were propensity score-weighted to the dextromethorphan-bupropion cohort. Patient characteristics were assessed during the 6-month pre-index period. Post-index HCRU and healthcare costs (2023 USD) over 6 months were evaluated using regressions adjusting for pre-index costs.

RESULTS

Each weighted cohort included 1,472 patients (mean age 43 years; 66.7% female). Compared with patients initiating dextromethorphan-bupropion, patients initiating cariprazine, brexpiprazole, or esketamine had higher odds of emergency room visits (odds ratios [ORs]: 1.35, 1.23, and 1.34, respectively; all p < 0.05) and inpatient admissions (ORs: 1.40, 1.19, and 1.11, respectively; p < 0.05 for cariprazine). Adjusted mean total healthcare costs were $18,715 for dextromethorphan-bupropion versus $19,931, $20,762, and $41,954 for cariprazine, brexpiprazole, and esketamine, respectively (p = 0.05 vs cariprazine; p < 0.05 vs brexpiprazole and esketamine). Adjusted mean medical costs were $9,154 vs $10,335, $10,352, and $23,934, and mean pharmacy costs were $9,272 vs $10,060, $11,015, and $21,561, respectively (all p < 0.05).

LIMITATIONS: Claims data may be subject to incomplete information, coding errors, residual confounding, and channeling bias. Clinical severity, treatment response, and therapy line were unknown.

CONCLUSIONS

In adults with MDD initiating selected branded treatments in routine US clinical practice, dextromethorphan-bupropion initiation was associated with lower all-cause HCRU and healthcare costs compared with initiation of cariprazine, brexpiprazole, or esketamine.