|Lead author (Year)||Intervention||Perspective (reasons)||Time horizon used in economic evaluation (reasons)||Discounting||Key cost-effectiveness results|
|RCT or cohort-based economic evaluations|
|Boath (2003) ||PBDU customised treatment||Societal||6 months (practical considerations, budgetary constraints)||Costs: 6%||“The current treatment of postnatal depression is dominated on the grounds of cost-effectiveness by PBDU treatment. The move from RPC to PBDU would incur an additional cost expended per successfully treated woman of £1945.”|
|Dukhovny (2013) ||Telephone-based peer support intervention, access to standard postpartum care||Societal (US and Canadian guidelines) Third-party payer, Healthcare, Family perspective||12 weeks (RCT time horizon)||No**||
The intervention was found to be cost-effective.|
CAD $10,009 per case of PND averted
There is 95% probability that the program would cost less than CAD $20,196 per PND case averted
|Hiscock (2007) ||Individual structured maternal and child health consultations, a choice of behavioural interventions, ‘controlled crying’ or ‘camping out’||NHS/PSS*||10, 12 months||No||
Infant sleep problems
At 10 months, 56% of intervention and 68% of control mothers reported infant sleep problems (OR 0.61, p = 0.04); At 12 months, this fell to 39% vs 55% (OR 0.53, p = 0.007).
Intervention mothers had lower mean EPDS scores than controls at 12 months (5.9 vs 7.2, p = 0.001) and higher mental health (SF-12) scores at both 10 months (48.1 vs 45.0, p = 0.001) and 12 months (49.7 vs 46.1, p = 0.001).
Intervention: £96.93 (SD, £249.37)
Control: £116.79 (SD, £ 330.31)
Mean difference: £19.44 (95% CI £283.70 to £44.81, p = 0.55)
|MacArthur (2003) ||Redesigned model of community postnatal care (midwifery-led)||Healthcare||12 months||No**||“The cost-consequences analysis established that the costs of the intervention and control care were broadly equivalent. The intervention care costing at a maximum £81.90 more per woman to deliver, but possibly representing a saving of £78.30 per woman, depending on assumptions used.”|
|Morrell (2000) ||Community midwifery support worker||Healthcare||
(Valid use of EPDS enabling comparability with other trials)
Given that health outcomes were similar for both groups, the economic analysis is limited to a comparison of costs between the intervention and control groups.|
Mean total cost to the NHS at 6 weeks (primary analysis)
Intervention group: £635 (SD, £326)
The control group: £456 (SD, £291)
Mean difference: £180 (95% CI, £126, £232, p = 0.001).
|Morrell (2009) ||Health visitor trained to identify and deliver CBA or person-centred approach||NHS/PSS (NICE guidelines)||6 months||No**||The intervention dominated the comparator for at-risk women at 6 months (primary analysis). However, a significant difference was not observed in the number of QALYs gained in the intervention groups compared to the control group and there was uncertainty associated with the cost and QALY pairs. The probability of CBT being cost-effective was just over 70%***|
|Petrou (2006) ||Counselling and support package by trained health visitors||Healthcare||
(RCT time period)
The intervention is cost-effective compared to RPC.|
£43.1 per month of PND avoided.
The probability that the intervention is cost-effective exceeds 70% once decision makers express a willingness to invest £1000 to prevent each month of PND.
|Price (2015) ||Enhanced engagement in home visiting via motivational interviewing and brief intervention (CBT and Interpersonal Therapy)||Service providers*||12 weeks||No||
“A decrease in depressive symptoms associated with the intervention that approached statistical significance (p = 0.0600). Significant increase in perceived social support (t = 3.35, p = 0.0027).”
Usual care: $158.30 per participant
Enhanced Engagement: $147.50 per participant
|Sembi (2016) ||Telephone peer support||Healthcare||6 months||No||
Benefits (primary outcomes)|
No significant differences between-subjects and improvement in mother-infant interaction.
Mean cost of the combined use of NHS resources
For the intervention group: £800.67 (SD, £761.74)
For standard care group: £1537.80 (SD, £1936.37).
It was not possible to conduct a cost-effectiveness analysis due to the small number of patients.
|Wiggins (2004) ||Health visitor support or Community group support||Healthcare, Patients||12,18 months||6% (costs)||
There was no clear difference in any of the primary outcomes.
Maternal depression: Fewer women in the combined intervention group scored over the depression threshold on the EPDS (−3%) than the control group
The Support Health Visitor intervention emerged as a relatively expensive intervention to implement compared with the Community Group Support intervention.
Support Health Visitor = £3255 (SD, £2253)
Community Group Support: £3231 (SD, £3323)
Control group: £2915 (SD, £2349)
|Model-based economic evaluations|
|Battye (2012) ||Befriending service (telephone helpline and one-to-one support by trained ‘befriender’ volunteers)||Societal, public sector (demonstrate value to society and healthcare)||
3, 6 and 30 years
The befriending service was cost-beneficial to both society and the state.|
For every £1 invested, the estimated SROI:
▪ £3 over the short term
▪ £4 over the medium term
▪ £6.50 over the longer term
Public sector perspective
For every £1 invested, the estimated SROI:
▪ £0.20 over the short term
▪ £0.20 over the medium term
▪ £1.50 over the longer term
|Bauer (2011) ||Universal health visiting (postnatal screening using EPDS and treatment [CBT + antidepressant])||Societal*||12 months||No||
Health visiting intervention provided a positive net benefit.|
£4500 per QALY gained
Net monetary benefits
£640 per mother (at WTP threshold of £20,000).
By extrapolation, this amounts to around £300 million for England.
|Campbell (2008) ||
programme (using PHQ-2) and treatments according to severity of PND.
The proposed routine screening programme appears to be highly cost-effective compared to the current practice from a government perspective.|
• NZ $287 per additional case detected
• NZ $400 per additional case resolved
• NZ $3461 per additional QALY gained
|Hewitt (2009) ||
1. Structured psychological therapy
2. Listening visit
(Both with preceding additional care)
The identification strategies were not cost-effective compared to the current practice.
EPDS at a cut point of 16: 3£41,204 per QALY gained.
Other cut points and BDI cut point 10 were either dominated or had ICERs higher than that of EPDS cut point 16.
At each of the three WTP thresholds considered (£20,000, £30,000 and £40,000), the strategy with the highest individual probability of being cost-effective was routine case detection.
Structured psychological therapy was a cost effective treatment** but listening home visits was not cost-effective compared to the current practice.
Structured psychological therapy: £17,481 per QALY gained
Listening home visits: £66,275 per QALY gained
There was 50% probability that structured psychological therapy would be cost-effective at a WTP threshold of £20,000 per QALY gained.
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)
|NHS/PSS (NICE guidelines)||
12 months 7 weeks
The ‘Whooley questions’ followed by PHQ-9 was estimated to be the most cost-effective identification strategy, however, well above the NICE threshold**.
Whooley questions followed by EPDS versus Whooley questions followed by PHQ-9: £45,593 per QALY gained
Facilitated self-help compared with standard care was overall more effective and more costly.
Facilitated self-help: £2269 per additional woman improving and not relapsing at the end of the model, or £13,324 per QALY gained.
The probability of facilitated self-help being cost effective is 0.59 to 0.72***.
|Stevenson (2010) ||Group CBT||
The group CBT compared with RPC was not found to be cost-effective.***|
CBT: £46,462 per QALY gained (95% CI, £37,008 to £60,728).
|Taylor (2014) ||Social support (e.g. advocacy, befriending)||
(to determine value to society)
|12 months-over a lifetime||3.5% (outcomes)||
Estimated average direct financial cost of providing support: £2230 per woman.|
Using SF-6D: £591–£887 per woman treated
Using EQ-5D: £1302–£1954 per woman treated