Dextromethorphan-bupropion (Auvelity®, Axsome Therapeutics) had improved efficacy for the treatment of major depressive disorder (MDD) compared with standard first-line treatments; however, the therapeutic was not cost-effective and may be better suited for second-line treatment, according to a study presented at the AMCP 2025 Annual Meeting.
Traditional first-line therapies for MDD include selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, but many patients require further treatment lines to induce outcomes.
Dextromethorphan-bupropion is a potential second-line treatment for MDD, so the study assessed its cost-effectiveness compared with standard treatments using a cohort-based decision tree model over 12 months.
Dextromethorphan-bupropion resulted in slightly greater effectiveness, with a utility of 0.66 compared to 0.65 for standard of care. However, dextromethorphan-bupropion had an incremental cost of $9,868.41, resulting in an Incremental Cost-Effectiveness Ratio (ICER) of $518,107.86 per quality-adjusted life-year gained.
The researcher noted that dextromethorphan-bupropion would be cost-effective if its annual price was less than $4,482.90, assuming similar remission rates were maintained.
“[Dextromethorphan-bupropion] could be considered as a second-line therapy, particularly in treatment-resistant patients with favorable ICER,” the author concluded. “Further research into pricing and long-term outcomes is needed to better determine its place in clinical practice for MDD.”
Reference
Ganna S. Cost-effectiveness of dextromethorphan-bupropion (Auvelity) among major depressive disorder adult patients. Abstract F2. Presented at AMCP 2025; March 31–April 3, 2025; Houston.
