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An economic evaluation of universal and targeted case-finding strategies for identifying antenatal 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


Elizabeth M Camacho

Gemma E Shields

Emily Eisner

Elizabeth Littlewood

Kylie Watson

Dean McMillan

Shehzad Ali

Simon Gilbody


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. [Abstract copyright: © 2023. The Author(s).]

Journal Article Type Article
Acceptance Date Sep 30, 2023
Online Publication Date Oct 18, 2023
Deposit Date Nov 6, 2023
Journal Archives of women's mental health
Print ISSN 1434-1816
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Pages 10.1007/s00737-023-01377-2
Keywords Cost-effectiveness, Case finding, Antenatal depression