An economic evaluation of targeted case-finding strategies for identifying postnatal depression: A model-based analysis comparing common case-finding instruments



Camacho, Elizabeth M ORCID: 0000-0001-9574-7710, Shields, Gemma E, Eisner, Emily, Littlewood, Elizabeth, Watson, Kylie, Chew-Graham, Carolyn A, McMillan, Dean, Ali, Shehzad and Gilbody, Simon
(2023) An economic evaluation of targeted case-finding strategies for identifying postnatal depression: A model-based analysis comparing common case-finding instruments. Journal of Affective Disorders, 334. pp. 26-34.

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Abstract

<h4>Background</h4>Half of women with postnatal depression (PND) are not identified in routine care. We aimed to estimate the cost-effectiveness of PND case-finding in women with risk factors for PND.<h4>Methods</h4>A decision tree was developed to represent the one-year costs and health outcomes associated with case-finding and treatment for PND. The sensitivity and specificity of case-finding instruments, and prevalence and severity of PND, for women with ≥1 PND risk factor were estimated from a cohort of postnatal women. Risk factors were history of anxiety/depression, age < 20 years, and adverse life events. Other model parameters were derived from published literature and expert consultation. Case-finding for high-risk women only was compared with no case-finding and universal case-finding.<h4>Results</h4>More than half of the cohort had one or more PND risk factor (57.8 %; 95 % CI 52.7 %-62.7 %). The most cost-effective case-finding strategy was the Edinburgh Postnatal Depression Scale with a cut-off of ≥10 (EPDS-10). Among high-risk women, there is a high probability that EPDS-10 case-finding for PND is cost-effective compared to no case-finding (78.5 % at a threshold of £20,000/QALY), with an ICER of £8146/QALY gained. Universal case-finding is even more cost-effective at £2945/QALY gained (versus no case-finding). There is a greater health improvement with universal rather than targeted case-finding.<h4>Limitations</h4>The model includes costs and health benefits for mothers in the first year postpartum, the broader (e.g. families, societal) and long-term impacts are also important.<h4>Conclusions</h4>Universal PND case-finding is more cost-effective than targeted case-finding which itself is more cost-effective than not case-finding.

Item Type: Article
Uncontrolled Keywords: Postnatal depression, Perinatal depression, Edinburgh Postnatal Depression Scale, Case-finding, Cost-effectiveness
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 25 May 2023 10:40
Last Modified: 27 Sep 2023 10:26
DOI: 10.1016/j.jad.2023.04.106
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3170656