An economic evaluation of universal and targeted case-finding strategies for identifying antenatal depression: a model-based analysis comparing common case-finding instruments.

Antenatal depression Case finding Cost-effectiveness

Journal

Archives of women's mental health
ISSN: 1435-1102
Titre abrégé: Arch Womens Ment Health
Pays: Austria
ID NLM: 9815663

Informations de publication

Date de publication:
18 Oct 2023
Historique:
received: 01 05 2023
accepted: 30 09 2023
medline: 18 10 2023
pubmed: 18 10 2023
entrez: 18 10 2023
Statut: aheadofprint

Résumé

Half of women with depression in the perinatal period are not identified in routine care, and missed cases reflect inequalities in other areas of maternity care. Case finding (screening) for depression in pregnant women may be a cost-effective strategy to improve identification, and targeted case finding directs finite resources towards the greatest need. We compared the cost-effectiveness of three case-finding strategies: no case finding, universal (all pregnant women), and targeted (only pregnant women with risk factors for antenatal depression, i.e. history of anxiety/depression, age < 20 years, and adverse life events). A decision tree model was developed to represent case finding (at around 20 weeks gestation) and subsequent treatment for antenatal depression (up to 40 weeks gestation). Costs include case finding and treatment. Health benefits are measured as quality-adjusted life years (QALYs). The sensitivity and specificity of case-finding instruments and prevalence and severity of antenatal depression were estimated from a cohort study of pregnant women. Other model parameters were derived from published literature and expert consultation. The most cost-effective case-finding strategy was a two-stage strategy comprising the Whooley questions followed by the PHQ-9. The mean costs were £52 (universal), £61 (no case finding), and £62 (targeted case finding). Both case-finding strategies improve health compared with no case finding. Universal case finding is cost-saving. Costs associated with targeted case finding are similar to no case finding, with greater health gains, although targeted case finding is not cost-effective compared with universal case finding. Universal case finding for antenatal depression is cost-saving compared to no case finding and more cost-effective than targeted case finding.

Identifiants

DOI: 10.1007/s00737-023-01377-2 PMID: 37851079
pubmed: 37851079
doi: 10.1007/s00737-023-01377-2
pii: 10.1007/s00737-023-01377-2
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Research for Patient Benefit Programme
ID : NIHR203474

Informations de copyright

© 2023. The Author(s).

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Auteurs

Elizabeth M Camacho (EM)

School of Health Sciences, University of Manchester, Manchester, UK. elizabeth.camacho@manchester.ac.uk.
Institute of Population Health, University of Liverpool, Liverpool, UK. elizabeth.camacho@manchester.ac.uk.
ORCID: 0000-0001-9574-7710

Gemma E Shields (GE)

School of Health Sciences, University of Manchester, Manchester, UK.

Emily Eisner (E)

School of Health Sciences, University of Manchester, Manchester, UK.
Manchester Mental Health NHS Foundation Trust, Manchester, UK.

Elizabeth Littlewood (E)

Department of Health Sciences, University of York, York, UK.

Kylie Watson (K)

Manchester University NHS Foundation Trust, Manchester, UK.

Carolyn A Chew-Graham (CA)

School of Medicine, Keele University, Keele, UK.

Dean McMillan (D)

Hull York Medical School and Department of Health Sciences, University of York, York, UK.

Shehzad Ali (S)

Hull York Medical School and Department of Health Sciences, University of York, York, UK.
Schulich School of Medicine & Dentistry, Western University, London, Canada.

Simon Gilbody (S)

Hull York Medical School and Department of Health Sciences, University of York, York, UK.

Classifications MeSH