Impact of Mental Health Screening Access on Incremental Cost Estimates Among Patients with Postpartum Depression

OBJECTIVES: While the incremental economic burden of postpartum depression (PPD) has been quantified previously, published estimates do not ensure that control patients have access to postpartum mental health screenings. The objective of this analysis was to explore the impact of PPD screening on incremental post-delivery cost estimates using real-world data.

METHODS: Women aged 12-55 with evidence of childbirth from 1/1/2016-6/30/2023 and continuous enrollment 1 year pre-/post-delivery were identified in a U.S. dataset that includes administrative and claims data for over 170 million patients across commercial payors, Medicare Advantage and Medicaid. A cohort with PPD (identified by a combination of PPD-related diagnosis, procedure, and/or treatment 1-year post-delivery) were propensity score matched to patients without PPD based on demographics, payor, and baseline health expenditures. Patients with baseline psychosis, bipolar disorder, or schizophrenia were excluded. All-cause healthcare costs during 1-year post-delivery (excluding delivery event) were assessed in both cohorts. Among the control cohort, regression analysis was used to evaluate 1) the relationship between demographics and PPD screening within 1-year post-delivery, and 2) the relationship between PPD screening and log-transformed post-delivery costs, controlling for baseline demographics and expenditures.

RESULTS: PPD pregnancies (N=7,815) incurred higher total healthcare costs than non-PPD pregnancies (N=15,247) during the 1-year following delivery ($4,106 vs $1,853, p <0.01). Among non-PPD controls, evidence of a PPD screening was observed in 7.33% of the sample and was more common among Hispanic patients (OR: 1.40; p<0.01, relative to Caucasian) and those with Medicaid insurance (OR: 1.66; p<0.01, relative to commercial). PPD screening was associated with 36% higher (p<0.01) post-delivery costs among non-PPD controls.

CONCLUSIONS: Patients with PPD incurred higher costs during the first year following childbirth than matched controls, however, ensuring that all controls have been screened for PPD may influence the magnitude of this estimate as well as other economic burden analyses among this patient population.