Exploring the cost-effectiveness of case-finding for antenatal depression: an economic modelling study

Camacho, Elizabeth ORCID: 0000-0001-9574-7710, Shields, Gemma, Eisner, Emily, Chew-Graham, Carolyn, Gilbody, Simon, Littlewood, Elizabeth, McMillan, Dean and Watson, Kylie (2023) Exploring the cost-effectiveness of case-finding for antenatal depression: an economic modelling study. British Journal of General Practice, 73 (suppl ). bjgp23X733977-bjgp23X733977.

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Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>The NHS has limited human and financial resources, with particular pressures in primary care. The National Institute for Health and Care Excellence (NICE) makes decisions on which services can be commissioned within the NHS. Many women experiencing antenatal depression are not identified as such in routine care and so may not access support. Current NICE guidance does not recommend universal case-finding for antenatal depression; however, a programme targeted towards pregnant women with risk factors (for example, previous mental illness, traumatic life events) has not been considered.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To explore the cost-effectiveness of case-finding for antenatal depression: targeted vs. universal vs. no case-finding.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>The following case-finding tools were evaluated: Edinburgh Postnatal Depression Scale, Whooley questions, PHQ-9. One- and two-stage strategies were considered (second tool administered following positive response to Whooley questions). A decision tree model of costs and health outcomes from 20–40 weeks’ gestation was developed. Health was measured as quality-adjusted-life-years (QALYs). Costs included case-finding and treatment for depression.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The two-stage Whooley/PHQ-9 option was the most cost-effective case-finding strategy. Implementing a universal case-finding strategy was associated with lower costs than no case-finding (£52 vs £61) and more QALYs (0.3458 vs 0.3455). Targeted case-finding has similar costs to no case-finding and more QALYs (0.3459), requiring a spend of £1775 to improve health by 1 QALY.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Universal case-finding for antenatal depression is cost-saving and improves health compared with no case-finding. It should be considered by policymakers to improve the identification and support of women experiencing antenatal depression in primary and maternity care.</jats:p></jats:sec>

Item Type:	Article
Uncontrolled Keywords:	Comparative Effectiveness Research, Brain Disorders, Depression, Clinical Research, Health Services, Cost Effectiveness Research, Mental Health, 8.1 Organisation and delivery of services, 8 Health and social care services research, Mental health, Reproductive health and childbirth, 3 Good Health and Well Being
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	18 Dec 2023 10:00
Last Modified:	15 Mar 2024 20:16
DOI:	10.3399/bjgp23x733977
Related URLs:	Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3177493