Table 1 Study characteristics and aims
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. Treatment: 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 12Â 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 1. EPDS 2. Beck Depression Inventory Treatments 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 Treatment: Hypothetical cohorts of 1000 women with depression in the postnatal period | Identification: Evaluate the cost-effectiveness for a range of feasible identification strategies for PND in primary care. Treatment: Clarify from the NICE guidance whether treatment strategies were cost-effective compared with usual care. | CUA |
NCCMH (2014) [38] | Identification 1. EPDS only 2. Whooley questions followed by EPDS 3. Whooley questions followed by PHQ-9 Treatment 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. Treatment: Hypothetical cohorts of 1000 women with sub-threshold/mild to moderate depression | Identification: Assess the relative cost-effectiveness of formal identification methods for PND. Treatment: Assess the cost-effectiveness of different types of psychological and psychosocial, relative to standard postnatal care alone. | CUAa, CEAa |
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 |