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

Camacho, Elizabeth M.; Shields, Gemma E.; Eisner, Emily; Littlewood, Elizabeth; Watson, Kylie; Chew-Graham, Carolyn A.; McMillan, Dean; Ali, Shehzad; Gilbody, Simon

Abstract

Background
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.

Methods
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.

Results
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.

Limitations
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.

Conclusions
Universal PND case-finding is more cost-effective than targeted case-finding which itself is more cost-effective than not case-finding.

Citation

Camacho, E. M., Shields, G. E., Eisner, E., Littlewood, E., Watson, K., Chew-Graham, C. A., …Gilbody, S. (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, 26-34. https://doi.org/10.1016/j.jad.2023.04.106

• Journal Article Type: Article
• Acceptance Date: Apr 28, 2023
• Online Publication Date: May 2, 2023
• Publication Date: 2023-08
• Deposit Date: May 25, 2023
• Journal: Journal of Affective Disorders
• Print ISSN: 0165-0327
• Electronic ISSN: 1573-2517
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 334
• Pages: 26-34
• DOI: https://doi.org/10.1016/j.jad.2023.04.106
• Keywords: Psychiatry and Mental health; Clinical Psychology
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S016503272300592X?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: An economic evaluation of targeted case-finding strategies for identifying postnatal depression: A model-based analysis comparing common case-finding instruments; Journal Title: Journal of Affective Disorders; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jad.2023.04.106; Content Type: article; Copyright: © 2023 The Authors. Published by Elsevier B.V.