Estimating the economic costs of antidepressant discontinuation during pregnancy.
OBJECTIVE
Depression is a major public health concern that results in a wide range of economic costs to people, their families, and the health care system. Our study sought to determine the direct medical costs incurred by the Ontario government owing to cessation of antidepressant therapy during pregnancy.


METHODS
We conducted an economic evaluation by making assumptions based on data obtained from Statistics Canada, federal and provincial government reports, and relevant depression literature. The analysis included the number of pregnant women with depression residing in Ontario and, subsequently, the number of those women who experienced depressive relapse during pregnancy owing to discontinuation of antidepressant medication. The cost of physician services, hospitalizations, and the birth of preterm and low birth weight infants (2 adverse outcomes associated with untreated depression during pregnancy) were also taken into consideration.


RESULTS
An estimated 2953 pregnant women with depression in Ontario annually discontinue antidepressant therapy and subsequently have a depressive relapse. An estimated $20 546 982 is spent annually in Ontario on untreated maternal depression in pregnancy; this is the total after subtracting the cost of risks associated with treated depression during pregnancy ($3 144 053).


CONCLUSIONS
Safe treatment options for the management of depression during pregnancy should be actively explored as treated depression translates into cost savings for the Ontario government and society as a whole. Beyond this cost, depression interferes with the quality of childrearing, maternal responsiveness to infants, and other determinants essential for optimal child development.
O'Brien
Lisa
L
Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario. lobrien14@gmail.com
Laporte
Audrey
A
Koren
Gideon
G
D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D003153:Community Health Services / Q000191:economics / Q000706:statistics & numerical data; D000075202:Contraindications; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000191:economics / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000191:economics; D009864:Ontario; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D018570:Risk Assessment; D055502:Secondary Prevention
D000928:Antidepressive Agents