A Cost-Utility Analysis of Screening and Cognitive Behavioral Therapy compared to usual care for Perinatal Depression

Abstract

Background: Perinatal depression is common and the most prevalent cause of maternal mortality, implementing effective depression screening and therapy is a priority for public health internationally. Objective: The aim of this study is to estimate the cost-effectiveness of implementing a strategy of perinatal depression screening with Cognitive Behavioral Therapy (CBT) compared with the current Treatment as Usual alone (TAU) for individuals with perinatal depression. Methods: A decision tree model was constructed to estimate the potential cost and utility benefits for screening using the Whooley Questionnaire followed by referral to CBT compared to TAU alone in Hong Kong. The model used healthcare costs, in Hong Kong Dollars (HKD), and quality-adjusted life years (QALYs) to estimate economic and health utility outcomes. We used two states (remission, and depression) modeled over a single perinatal period, such as transfer probabilities, depression-specific quality of life, and cost data were retrieved from published studies. Deterministic and probabilistic sensitivity analyses were conducted to estimate the stability of the model. Results: The baseline analysis suggested Whooley combined with CBT or TAU yielded an additional 0.02 QALY compared to TAU alone but added 900.26 HKD to the cost of treatment per patient. Our deterministic sensitivity analysis indicates several variables that have the greatest impact on the model. Our probabilistic sensitivity analysis shows that Whooley combined with CBT or TAU is approximately 84% more cost-effective than TAU alone at a willingness-to-pay (WTP) threshold of 194,780 HKD. Conclusions: Whooley combined with CBT is estimated to be cost-effective in identifying and treating individuals with perinatal depression at an early stage compared to TAU alone. More research is required to assess the feasibility, cost-benefit, and clinical effectiveness of this strategy.