[Cariprazine image courtesy of PubChem]

The Vraylar (cariprazine), which recently scored FDA approval as an adjunctive treatment for Major Depressive Disorder (MDD), could have positive implications for healthcare resource utilization. A new analysis suggests that this atypical antipsychotic, initially developed by Allergan (now AbbVie), could curb healthcare spending of MDD treatment.

In the economic analysis, patients who received cariprazine as their first adjunctive therapy had 45% fewer MH-related hospitalizations and 33% fewer outpatient visits per patient-year than those who received it as a subsequent adjunctive therapy. Additionally, patients starting cariprazine as their first adjunctive therapy also had $2,182 lower total MH-related healthcare costs per patient per year. This was largely a result of significantly lower outpatient visit costs, which were reduced by $1,511 per patient per year, relative to those who first tried another adjunctive treatment before cariprazine.

Cariprazine’s potential economic impact

The retrospective database analysis study, titled “Healthcare Resource Utilization and Costs of Using Cariprazine as the First Versus Subsequent Adjunctive Therapy for Major Depressive Disorder” was presented at the Psych Congress 2023. The study used data from the Truven Health MarketScan commercial database, covering January 1, 2015, to June 30, 2021. In all, the analysis identified 838 eligible patients, with 375 (44.7%) receiving cariprazine as their first adjunctive therapy and 463 (55.3%) as a subsequent adjunctive therapy.

Given the significant costs associated with treating MDD, early cariprazine could yield substantial savings for the healthcare system. FDA has approved relatively few new options for the condition in recent years. In 2022, the agency gave its nod to the oral N-methyl D-aspartate (NMDA) receptor antagonist Auvelity: an extended-release tablet that combines dextromethorphan HBr and bupropion HCl. Earlier this year, the agency denied an MDD indication for the neuroactive steroid Zurzuvae (zuranolone), but granted it approval for postpartum depression. Cariprazine won approval for use as an adjunctive treatment for MDD in late 2022.

The rising economic strain of MDD

In the U.S., the economic burden of Major Depressive Disorder was estimated at $236 billion in 2018, increasing by more than one-third since 2010. In the wake of the COVID-19 pandemic, depression rates have climbed. Nearly 29% of U.S. adults reported having been diagnosed with depression in their lifetime, a notable spike over prior years, according to data from Gallup in May 2023. Some 17.8% of Americans have been or are currently being treated for depression.

“Research has demonstrated that the economic burden of MDD is substantial,” said Dr. Prakash Masand, adjunct professor at Duke-NUS. The annual overall costs for MDD, including direct, suicide-related, and workplace (indirect) costs, was around $326 billion in the United States, according to a 2021 analysis in PharmacoEconomics.

Although a significant portion of those expenses trace back to workplace-related costs, direct treatment costs also contribute to the total economic burden of MDD. Treating MDD is often complex and achieving remission can often be challenging. In the Sequenced Treatment Alternatives to Relieve Depression (STAR∗D) clinical trial, one of the largest depression studies that concluded in 2006, remission rates with first line antidepressant monotherapy were 33% and response rates were 47%. “Therefore, many patients may cycle through multiple lines of therapy before finding a treatment that works for them,” Masand noted. “Importantly however, STAR*D found that the likelihood of achieving remission seems to decrease with each subsequent treatment step.”

A separate analysis showed that cariprazine may have potential in treating anhedonia, one of the chief symptoms of MDD.

A closer look at cariprazine MDD cost savings: Implications of early use

The potential costs of reducing MDD-related hospitalizations alone could be significant.  According to a 2019 analysis, the average hospital stay for MDD lasts approximately 6 days, incurring an average cost of $6,713 per hospitalization.

The toll of MDD, however, is more than financial. Masand notes that the analysis on cariprazine’s economic potential may have underestimated the overall costs of MDD because the impact on patient’s lives and their families can be difficult to measure.

He also highlights limitations in interpreting the results of this study. First, because the study focused on patients who used cariprazine as adjunctive therapy at some point for their MDD, the results don’t generalize to all patients with MDD. “Patients in this study were followed for ~1.2-1.7 years after their adjunctive treatment initiation, therefore, longer-term outcomes and costs could not be assessed,” he added. Masand also noted that such datasets have some inherent limitations such as “potential for missing data and limited clinical information, and therefore, reasons for use of these health care services are unknown and causal conclusions cannot be drawn.”

With CDC and others noting surging depression rates in the U.S., confronting the economic impact of the condition remains of paramount importance.