(366) Healthcare costs for patients with major depressive disorder initiating dextromethorphan-bupropion extended-release tablets as a first or subsequent line of treatment

Background: : Major depressive disorder (MDD) is a chronic condition with unmet needs despite many established treatment options. Auvelity® (dextromethorphan-bupropion [DM-BUP]) is an oral, N-methyl-D-aspartate (NMDA) receptor antagonist and sigma-1 agonist approved in the US for the treatment of adults with MDD. This study evaluated real-world healthcare costs in patients with different pharmacologic treatment histories initiating DM-BUP for MDD.

Objective: : To examine healthcare costs over 6 months among patients with MDD initiating DM-BUP who were treatment-naïve or had 1 or 2+ prior MDD treatments.

Methods: : Adults with MDD who initiated DM-BUP were identified in the Merative™ MarketScan® Commercial and Medicare databases (Jan 2021–Mar 2024). Included patients had continuous enrollment for 6 months pre- and post-initiation of DM-BUP (index date = 1st prescription date). Patients were divided into subgroups according to the number of MDD treatments in the pre-initiation period: 0, 1, or 2+. Multivariate regressions were conducted to examine healthcare costs, adjusting for differences in age, gender, and comorbidities.

Results: : Among 1,472 patients initiating DM-BUP, 160 (10.9%), 367 (24.9%), and 945 (64.2%) were MDD treatment-naïve or had 1 or 2+ prior MDD treatments, respectively. Treatment-naïve patients were younger, more likely to be male, and had fewer mental health-related comorbidities than those with 1 or 2+ prior MDD treatments (all P < 0.05). Treatment-naïve patients had lower total costs vs patients with 1 or 2+ prior MDD treatments ($13,025 vs $15,054 and $23,484, respectively; P < 0.05 for 2+ vs 0 prior treatments). Similarly, inpatient ($434 vs $583 and $2,922, respectively), outpatient ($5,446 vs $6,384 and $9,112), and pharmacy costs ($7,056 vs $7,926 and $11,537) were lower for treatment-naïve patients than those with 1 or 2+ prior MDD treatments (all P < 0.05 for 2+ vs 0 prior treatments). MDD-related and mental health-related costs were also significantly lower among treatment-naïve patients than those with 1 or 2+ prior MDD treatments (both P < 0.05). Across all analyses, costs were also lower for patients receiving 1 vs 2+ prior MDD treatments (all P < 0.05).

Sponsorship:: Axsome Therapeutics, Inc.