The Real Scoop About That New PPD Drug
This week, the FDA approved the first treatment specifically designed for patients suffering from moderate to severe postpartum depression, which will likely hit the market this summer. Sage Therapeutics’ Zulresso (brexanolone) is delivered via intravenous infusion over the course of 60 hours, and needs to be administered in a healthcare facility that can properly monitor the patients.
Zulresso is a synthetic version of a steroid called allopregnanolone, which the body naturally produces. Levels in the blood rise during pregnancy, then abruptly drop after childbirth. Some people are particularly sensitive to this hormonal fluctuation, and can develop anxiety and depression in response.
In clinical trials, patients who took Zulresso saw a significant improvement compared to placebo within 60 hours, and the effects lasted at least 30 days (which was the time of the last follow-up; we don’t know yet how long it lasts beyond that).
Unfortunately, on top of the burdensome three-day hospital stay, it can cost up to $34,000. This has a lot of people (rightfully) complaining about accessibility. But how much of a problem is it?
First, the inpatient stay: Many new parents are either unwilling or unable to leave their new baby (not to mention older kids!) for three days. Organizing three days of childcare is complicated enough without throwing a new baby (who maaaaybe sleeps through the night?) into the mix. Paid childcare is expensive, there isn’t always a second parent or other family to help, and taking an otherwise healthy newborn back into a hospital isn’t always the best idea (hello, germs!).
We should keep in mind that this drug was designed for severe cases of PPD that may not respond to other treatment, many of which may require hospitalization anyway. Even if patients aren’t otherwise hospitalized, my hope is that providers can design a program that would provide childcare and a family-friendly infusion space, and possibly even counseling or childcare education during the time of the infusion. This could provide a more holistic treatment approach, as we know that the combination of meds and therapy is more effective than meds alone.
Second, the cost: The $34,000 price tag is definitely high, and this doesn’t necessarily include other inpatient fees that would be incurred during treatment, but this also does not take into account insurance coverage (which, to be fair, remains to be seen) or other discount programs the company is likely to set up.
For comparison, one study estimated that a year’s worth of Rituxan (rituximab) infusions for rheumatoid arthritis can cost upwards of $33,000 before insurance. Insurance reduces this to a smaller copay, and drug companies have patient assistance programs that bring the cost down even further. For example, in one program, patients only pay a $5 copay, and others can receive about $4000 per year to reduce out-of-pocket costs. I would be surprised if they didn’t do something similar with Zulresso, because the drug company needs people to actually take it. (Yes, it might still be expensive to some. No, this isn’t fair.)
Still, the fact that a drug has been developed at all for patients with PPD is good news. These trials have been the first of their kind in this population, which in itself is important because it proved that the population is easy to study (duh, but scientists needed this in writing before they believed it). They even let patients breastfeed in the later studies, which is uncommon. These are all big steps in researching new meds for pregnant, postpartum, and nursing parents, which should lead to more research in this area, and hopefully greater accessibility and options for patients who desperately need it.
What other issues in postpartum/parental mental health would you like to see the healthcare industry address next? Personally, I’m waiting for the routine screening of non-birth parents for post-baby depression and anxiety; they’re going through a lot, too.