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Table 1 Study characteristics and aims

From: Identifying and assessing the benefits of interventions for postnatal depression: a systematic review of economic evaluations

Lead author (Year) Intervention Comparator Country Sample size, N; patient population Primary aims of economic evaluation Analytical approach
RCT or cohort-based economic evaluation
Boath (2003) [39] PBDU customised treatment (consisting of one or more of the following: individual, couple and family counselling, group therapy, creative therapy, hobbies and activities, stress management, assertiveness training, yoga and relaxation, a group for parents and older children and pharmacotherapy) RPC UK N = 60; Women with a baby aged 6 weeks-1 year, with the EPDS score above 12 and with a diagnosis of a major or minor depressive disorder. Assess the cost-effectiveness of two alternative approaches to the PND treatment. CEAa
Dukhovny (2013) [27] Telephone-based peer support intervention, access to standard postpartum care Usual care Canada N = 610; High-risk women with EPDS score > 9, able to speak English, following a live birth and discharge home Determine the cost-effectiveness of a peer support intervention to prevent PND. CEA
Hiscock (2007) [26] Individual structured maternal and child health consultations, a choice of behavioural interventions, ‘controlled crying’ or ‘camping out’ Usual care Australia N = 328; Mothers reporting an infant sleep problem in the concurrent 7-month questionnaire Assess the effectiveness and costs of an intervention targeting infant sleep problems. CCA
MacArthur (2003) [31] Redesigned model of community postnatal care (midwifery-led) Current care UK N = 36 clusters; All pregnant women registered at the practice antenatally from about 34 weeks gestation. Develop, implement and test the cost-effectiveness of redesigned postnatal care compared with current care on women’s physical and psychological health. CCA
Morrell (2000) [32] Community midwifery support worker Postnatal midwifery care UK N = 471; All women who delivered a baby at the recruiting hospital living within the study area, were aged 17 or over, and could understand English. Measure the effect and the total cost per woman of providing postnatal support at home. CMA
Morrell (2009) [37] Health visitor trained to identify and deliver CBA or person-centred approach Health visitor usual care UK N = 418; Women at risk of PND indicated by EPDS score ≥ 12, registered with participating GP practices, 36 weeks pregnant during recruitment, who had a live baby and were on a collaborating Health Visitor’s caseload. Investigate outcomes for postnatal women attributed to the intervention, and to establish its cost-effectiveness. CUAa
Petrou (2006) [33] Counselling and support package by trained health visitors RPC UK N = 151; Women attending clinics at 26–28 weeks of gestation, identified as at high risk of developing PND Assess the cost-effectiveness of a preventive counselling and support package for women at high risk of developing PND. CEA
Price (2015) [29] Enhanced engagement in home visiting via motivational interviewing and brief intervention (CBT and Interpersonal Therapy) Usual care USA N = 25; Pregnant and postpartum women in low-income and ethnic minorities communities meeting risk criteria for major depression Examine the feasibility of enhanced engagement in routine community care over usual care maternal and child health home visiting. CCAa
Sembi (2016) [41] Telephone peer support Standard care UK N = 28; Women > 16 years when giving birth, experiencing depressive symptom indicated by EPDS threshold ≥10 and/or clinical judgement, and potentially receptive to receiving intervention. Pilot a telephone peer-support intervention for women experiencing PND. CCAa
Wiggins (2004) [35] Health visitor support or Community group support Standard services UK N = 498; Women living in deprived areas, who gave birth in the specified time period and of any ethnicity. Measure the impact and cost-effectiveness of two alternative strategies for providing support to mothers in disadvantaged inner city area. CCAa
Model-based economic evaluation
Battye (2012) [30] Befriending service (telephone helpline and one-to-one support by trained ‘befriender’ volunteers) No intervention UK Quantitative study: N = 39
Qualitative study: N not provided
Demonstrate value for money of Acacia Family Support’s service. CBA
Bauer (2011) [42] Universal health visiting (postnatal screening using EPDS and treatment [CBT + antidepressant]) Routine postnatal care UK Identification:
Hypothetical cohort of women for screening.
Hypothetical cohort of women with moderate to severe PND for the treatment
Identify and analyse the costs and economic pay-offs of PND interventions. CUAa
Campbell (2008) [28] Routine screening
programme (using PHQ-2) and treatments (antidepressants, psychological therapies or social support) according to severity of PND.
Current practice New Zealand N not provided; Mothers who gave birth in any 12 month period, regardless of the number of previous births Evaluate value for money of implementing a screening programme for PND. CUAa, CEAa
Hewitt (2009) [36] Identification
2. Beck Depression Inventory
1. Structured psychological therapy
2. Listening visit
(Both with preceding additional care)
Current practice UK Identification:
Hypothetical population of postnatal women (depressed or not) managed in primary care six weeks postnatally
Hypothetical cohorts of 1000 women with depression in the postnatal period
Evaluate the cost-effectiveness for a range of feasible identification strategies for PND in primary care.
Clarify from the NICE guidance whether treatment strategies were cost-effective compared with usual care.
NCCMH (2014) [38] Identification
1. EPDS only
2. Whooley questions followed by EPDS
3. Whooley questions followed by PHQ-9
1. Facilitated self-help based on CBT principles
2. Listening visits
(Both in addition to standard postnatal care)
Standard care UK Identification:
Hypothetical cohorts of 1000 postnatal women undergoing screening for depression.
Hypothetical cohorts of 1000 women with sub-threshold/mild to moderate depression
Assess the relative cost-effectiveness of formal identification methods for PND.
Assess the cost-effectiveness of different types of psychological and psychosocial, relative to standard postnatal care alone.
Stevenson (2010) [40] Group CBT RPC UK Secondary RCT N = 45; Women meeting a standardised PND diagnosis or scoring EPDS threshold ≥12. Evaluate the clinical effectiveness and cost-effectiveness of group CBT compared with currently used packages. CUAa
Taylor (2014) [34] Social support (e.g. advocacy, befriending) No intervention UK Estimated N = 100; Women assessed as vulnerable to PND, either as a self-referral, or referred via the mid-wife/GP. Determine the benefits and costs of the Perinatal Support Project to prevent PND. CBAa
  1. CBA Cost-Benefit Analysis, CBA Cognitive Behavioural Approach, CBT Cognitive Behavioural Therapy, CCA Cost-Consequence Analysis, CEA Cost-Effectiveness Analysis, CMA Cost-Minimisation Analysis, CUA Cost-Utility Analysis, EPDS Edinburgh Postnatal Depression Scale, NCCMH National Collaborating Centre for Mental Health, PBDU Parent baby day unit, PHQ Patient Health Questionnaire, RCT Randomised Controlled Trial, RPC Routine primary care
  2. aNot explicitly stated by authors