Matched cohort study of healthcare resource utilization and costs in young children of mothers with postpartum depression in the United States

Abstract

Objective: To assess healthcare resource utilization (HRU) and costs in children of mothers with and without postpartum depression (PPD).

Methods: Administrative claims data from the IBM Watson Health MarketScan Databases (2010–2016) were used. Women with live births (index date = delivery date) were identified and linked to their newborns. The mother–child pairs were divided into PPD and non-PPD exposure cohorts based on claims for depression, mood or adjustment disorders, or anxiety identified in the mother between 15 and 365 days after delivery. Mother–child pairs with PPD exposure were propensity score matched 1:3 to mother–child pairs without PPD exposure. Children were required to have 24 months of continuous health plan enrolment following delivery. Additional comparisons were performed between mother–child pairs with and without preterm delivery.

Results: Overall, 33,314 mother–child pairs with PPD exposure were propensity score matched to 102,364 mother–child pairs without PPD exposure. During the 24-month follow-up period, HRU across most service categories was significantly higher among children in the PPD exposure cohort than non-PPD exposure cohort. Among outpatient services, the percentages of children with a physician specialist service (68% versus 64%), early-intervention screening (40% versus 37%), and an emergency room visit (48% versus 42%) were greater in children of mothers with PPD (all p < .001). Furthermore, children of mothers with PPD incurred 12% higher total healthcare costs in the first 24 months of life compared to children of mothers without PPD ($24,572 versus $21,946; p < .001). After excluding mothers with preterm delivery, the proportion of children with ER visits, physician specialist services, and outpatient pharmacy claims was significantly higher in the PPD exposure cohort than non-PPD exposure cohort (all p < .001).

Conclusion: The results of this analysis suggest that HRU and costs over the first 24 months of life in children of mothers with PPD exceeded that of children of mothers without evidence of PPD.

Keywords:

• Administrative claims analysis
• healthcare resource utilization
• healthcare costs
• children
• mothers
• postpartum depression

JEL CLASSIFICATION CODES:

• I11
• I12

Transparency

Declaration of funding

This study was funded by Sage Therapeutics, Inc., Cambridge, MA, USA.

Declaration of conflict of interests

Ming-Yi Huang and Adi Eldar-Lissai are employed by Sage Therapeutics, Inc. Elizabeth Packnett, Nicole Zimmerman, and Meghan Moynihan are employed by IBM Watson Health as consultants and received funding from Sage Therapeutics to conduct this study. Tiffany Moore Simas was a paid consultant of Sage Therapeutics. The peer reviewers on this manuscript have received an honorarium from JME for their review work. In addition, a reviewer on this manuscript has disclosed that they have worked for NICE Scientific Advice on pharmacological interventions for postpartum depression. The reviewers have no other relevant financial relationships or otherwise to disclose.

Acknowledgements

Medical writing services were provided by Santosh Tiwari, Ph.D. of IBM Watson Health with editorial support from Elizabeth Hoit Marchlewicz, Ph.D. of IBM Watson Health. These services were paid for by Sage Therapeutics, Inc.

Author contributions

Adi Eldar-Lissai, Elizabeth R. Packnett, and Ming-Yi Huang were involved in the conception of this study. Elizabeth R. Packnett, Nicole M. Zimmerman, and Meghan Moynihan were involved in the analysis of the data. All authors were involved in the design of the study, the interpretation of the data, and the drafting or revision of the manuscript. All authors have read and approved the final version of this submitted manuscript, and all authors agree to be accountable for all aspects of the work.

Previous presentations

This research was presented in part at the 2019 American College of Obstetrics and Gynecology Annual Meeting conference in Memphis, TN.