Antidepressant therapy during pregnancy: an insight on its potential healthcare costs.

BACKGROUND Information on healthcare costs associated with poorly treated psychiatric disorders during and after pregnancy is limited. OBJECTIVE To compare the direct healthcare costs, during and after pregnancy, between women who continue their antidepressant therapy during the whole gestational period and those who discontinue their treatment during the first trimester. METHODS Data from a 'Medications and Pregnancy' registry were used. Eligible women were 1) aged 15 - 45, 2) insured by the Quebec drug plan for > or =12 months prior to, during, and > or =3 months after pregnancy, 3) had > or =1 diagnoses of psychiatric disorders before pregnancy, 4) used antidepressants for . or =30 days in the year before pregnancy, and 5) had delivered. Women who continued their antidepressant therapy throughout pregnancy (Group 1) were compared to those who discontinued during the first trimester (Group 2). Healthcare costs, expressed as mean total costs and cost ratios, were determined during and after pregnancy. RESULTS In total, 2822 women met inclusion criteria. Of these, 501 (17.8%) were in Group 1, and 676 (23.4%) in Group 2. The median number of days of antidepressant use before pregnancy was higher in Group 1 (260 days vs. 144 days, p<.01); the proportion of women visiting a psychiatrist was also higher in Group 1 (33.7% vs. 26.8%, p<.01). The mean total cost during pregnancy in Groups 1 and 2 were $2981.5 vs. $1842.9 (p<.01), respectively, and after pregnancy were $1761.2 vs. $1024.9 (p<.01), respectively. When prescription costs were excluded, these differences in costs were no longer significant. CONCLUSIONS Women who use antidepressants during pregnancy are likely to have disorders of greater severity compared to those who discontinue during the first trimester. They incur significantly greater healthcare costs. However, this increased cost is attributable to higher prescription costs.