Willingness-to-Pay Analysis of Zuranolone in Major Depressive Disorder: a US Societal Perspective

Abstract: OBJECTIVES: Evaluate clinical and economic outcomes of zuranolone, an investigational drug, versus standard-of-care (SOC) antidepressants in adult patients with major depressive disorder (MDD) to generate suggested value-based willingness-to-pay (WTP) ranges for zuranolone. METHODS: A Markov cost-utility model was developed in second-line treatment, comprising various health states (eg, remission, relapse). The comparator was composed of SOC antidepressants. The base case model incorporated data from the zuranolone WATERFALL Study (NCT04442490), the SHORELINE Study (NCT03864614), and literature for treatment efficacy and safety. US drug acquisition costs for SOC, healthcare resource utilization costs, adverse event costs, and indirect costs were derived from literature. RESULTS: In the 2-year analysis, zuranolone treatment was associated with lower healthcare resource utilization costs (-$6,519), adverse event costs (-$130), and indirect costs (-$3,988) vs SOC. Zuranolone was associated with higher quality-adjusted life years (QALYs) vs SOC, 49% of which were due to fewer adverse events. Although no head-to-head efficacy data exist, the model demonstrated potential for a 37% relative reduction in progression to subsequent treatment, driven by zuranolone’s treatment paradigm. Using common US WTP cost/QALY thresholds of $100-$150K, the value-based range of zuranolone price per treatment course, is estimated to be approximately between ~$9.5k-$11.6k from a societal perspective over a 2-year horizon. Changing to a 1-year time horizon or payer perspective (2 years) resulted in approximate value-based ranges of ~$5.7k-$7.1k and ~$7.5k-$9.6k, respectively. CONCLUSIONS: This study estimated ranges of suggested value-based WTP for zuranolone in the treatment for MDD, under which zuranolone may produce a net positive return to society.Short Description: Zuranolone is an investigational oral, once-daily, 14-day treatment for adults with MDD. An economic model was developed to indirectly compare zuranolone to standard-of-care antidepressant therapies from a societal and payer perspective. The findings demonstrated potential reductions in healthcare resource utilization costs, adverse event costs, and indirect costs. Additionally, the analysis estimated several value-based willingness-to-pay ranges for zuranolone.Name of Sponsoring Organization(s): Sage Therapeutics, Inc., and Biogen Inc.