Title : Assessing the incremental health care burden of postpartum depression
Abstract:
Background: Management and treatment of postpartum depression (PPD) incurs a significant utilization of inadequate health care resources, including costs associated with therapy, medications and both in- and out-patients visits. The availability of large health claims databases affords an opportunity and means to determine the prevalence of PPD and thereby estimate the incremental costs attributable to PPD by contrasting the PPD patients’ claims vs non-PPD patients.
Methods: Commercial claims datasets from 2 large providers (A and B) were used to estimate PPD prevalence and to summarize claims costs by PPD diagnosis. The longitudinal claims data (4+ years) was curated with the following conditions: (i) pregnancy indicator at least 2 months prior to birth, (ii) a minimum of 10 months medical history pre-birth, and (iii) a minimum of 6 months of medical history after birth (or until PPD diagnosis if earlier). Data A yielded ~110k pregnant women meeting the above criteria, of whom ~20k (18%) went on to develop PPD while Data B had ~440k women of whom ~93k (21%) went on to develop PPD. For Data A, claim codes were used to categorize the costs (for the period 10 months prior to birth and 6 months after birth) for “mental health”, “birth related” and “Total”. Given the richer information in Data B, the costs were categorized by “in-patient” (includes clinic and office visits), “out-patient” and “Total”.
Results: Claims database A showed significantly higher costs for PPD patients as compared to non PPD patients, ~$120k higher per patient. The incremental “mental health” costs (pre and post birth) were ~$41k.
The findings from Claims database B (not shown), though the categorizations differed, were overall consistent with higher burden for PPD patients ($9.7k incremental).
Conclusions: The estimated prevalence of PPD is similar in both databases (18% and 21%) and is consistent with published literature, with the caveat that a significant percentage of women may be undiagnosed. Incremental costs were significantly higher for PPD patients, and the observed difference was only partially due to “mental” health care. However, this may be an underestimate as diagnostic codes may not have fully captured the relevant items. There are a number of factors that could be influencing why the differences in mental health costs are not so large such as stigma and attitudinal barriers that could prevent women from seeking mental health services.
Audience Take Away:
- Given the recent focus on Maternal Health and Maternal mental health specifically, this paper highlights the needs to develop tools/strategies for identification and early intervention for women who have PPD. Highlights the prevalence of PPD and the difference in healthcare costs for women with PPD vs those without. Audience will become aware of the impact of PPD on overall health care resource use.
- This is a pressing issue that prevents diagnosis due to related costs and thus, many women go undiagnosed and uncared for. The audience, being made aware of this issue, will be able to use the data provided by this study to demand comprehensive care for PPD women and mitigate the cost burden placed upon them.
- Other faculty can use the statistics to present concrete evidence of the reason for financial burden and underdiagnosis of PPD and conduct a comparative analysis to women without PPD.
- Given specifics on costs up to birth, costs per birth, and total costs, a plan of cost management and cost benefits can be developed to assist the patient. These findings can also be used to provide insurance companies with additional plans to cover those suffering from PPD.
