Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial

Henderson, Catherine, Dixon, Simon, Bauer, Annette, Knapp, Martin, Morrell, C Jane, Slade, Pauline ORCID: 0000-0001-5877-2706, Walters, Stephen J and Brugha, Traolach (2019) Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial. PSYCHOLOGICAL MEDICINE, 49 (8). pp. 1324-1334.

Text
final sub Cost-effectiveness PoNDER for mothers lower risk REV CLEAN (6).docx - Author Accepted Manuscript
Download (143kB)

Official URL: http://dx.doi.org/10.1017/s0033291718001940

Abstract

<h4>Background</h4>There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal.<h4>Methods</h4>Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12).<h4>Results</h4>In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%).<h4>Conclusions</h4>PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.

Item Type:	Article
Uncontrolled Keywords:	Cost-effectiveness, depression, health visitor, perinatal, prevention
Depositing User:	Symplectic Admin
Date Deposited:	27 Jul 2018 13:49
Last Modified:	19 Jan 2023 01:30
DOI:	10.1017/S0033291718001940
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3024260