Table 3 Description of outcomes used in model-based economic evaluations

Battye (2012) [30]

Befriending service (telephone helpline and one-to-one support by trained ‘befriender’ volunteers)

Short-term

• Improvements in mental health

• Increased awareness of PND and PND support

• Increased coping ability

Long-term

• Reduced infants behavioural problems

• Improved infants cognitive functioning

• Family functioning improvement Healthcare professionals and volunteers outcomes also measured.

Child, others^a and non-health

Short Warwick-Edinburgh Mental Wellbeing Scale, qualitative interviews and evaluation form

Questionnaires, qualitative interviews, monitoring data, and published studies

Intervention benefits will sustain in the future with only 20% drop-off.

–

Bauer (2011) [42]

Universal health visiting (postnatal screening using EPDS and treatment [CBT+ antidepressant])

• QALY

–

Utilities for depression states derived from secondary sources.

Bennett et al. [51] and Revicki and Wood [52]

Without treatment, PND will sustain with a short-term resolution. Symptoms of moderate-to-severe PND are comparable to those of moderate-to-severe depression.

Child and non-health; reasons for their non-inclusion not provided

Campbell (2008) [28]

Routine screening

programme (using PHQ-2) and treatments (antidepressants, psychological therapies or social support) according to severity of PND.

• PND cases detected

• PND cases resolved

• QALY

–

PHQ-2, Preference weights for QALYs derived from a secondary source.

Secondary sources, Revicki and Wood [52]

Normal utility six-weeks post-treatment in the treatment responders. Non-responders with mild/moderate depression recover within six months of its onset. PND will sustain in undetected cases and non-responders with severe depression. A linear deterioration or improvement between health states over time.

Child and non-health; child outcomes could not be included due to lack of reliable data

Hewitt (2009) [36]

Identification

1.EPDS

2. Beck Depression Inventory

Treatments

1. Structured psychological therapy

2. Listening visit

(Both with preceding additional care)

• QALY

–

Utility weights derived for QALYs from a secondary source.

Effectiveness estimate from a systematic review and meta-analysis, utility values from Revicki and Wood [52]

Non-responders to treatment and usual care would remain depressed until the model endpoint. Women enter the relevant treatment at 6 weeks postnatally. A linear deterioration or improvement between health states over time.

Child and partner/family; these outcomes could not be included due to lack of reliable data

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)

Identification

• QALY

Treatment

• QALY

• PND cases improved and not relapsed

–

EPDS, Whooley question, PHQ-9. Utility weights derived for QALYs from a secondary source.

Effectiveness estimate from meta-analyses, utility values from Sapin and colleagues [53], experts opinion

Identification

False negative women could have spontaneous recovery or be identified in the GP follow-up and offered treatment. Only first-line treatments considered and relapse not modelled.

Treatment

Women who improve remain in the state or relapse until the model endpoint. A linear deterioration or improvement between health states over time.

Child, partner/family and non-health; reasons for excluding non-health outcomes was the lack of relevant evidence

Stevenson (2010) [40]

Group CBT

• QALY

–

Changes in EPDS scores were translated to changes in utility using secondary data.

Data from Morrell et al. [37]

Benefits would sustain over the 6-month period with linear decline afterwards to zero, a year after the treatment.

Child and partner/family; reasons for their non-inclusion not provided

Taylor (2014) [34]

Social support

(e.g. advocacy, befriending)

• Increased well-being

• Increased chances of employment and higher earnings

• Long-term beneficial children outcomes

• Reduced use of health and social care services

• Increased tax revenues

• Volunteers benefits

Child, others^a and non-health

Hospital Anxiety and Depression Scale, analysis of a cohort study

Experts, a range of secondary sources

Benefits were estimated from an observational study and an RCT of similar service. Benefits for women and society inferred from experts and a range of published studies.

–