Cost-effectiveness of interventions for perinatal anxiety and/or depression: a systematic review

Abstract

ObjectivesAnxiety and/or depression during pregnancy or year after childbirth is the most common complication of childbearing. Economic evaluations of interventions for the prevention or treatment of perinatal anxiety and/or depression (PAD) were systematically reviewed with the aim of guiding researchers and commissioners of perinatal mental health services towards potentially cost-effective strategies.MethodsElectronic searches were conducted on the MEDLINE, PsycINFO and NHS Economic Evaluation and Health Technology Assessment databases in September 2017 to identify relevant economic evaluations published since January 2000. Two stages of screening were used with prespecified inclusion/exclusion criteria. A data extraction form was designed prior to the literature search to capture key data. A published checklist was used to assess the quality of publications identified.ResultsOf the 168 non-duplicate citations identified, 8 studies met the inclusion criteria for the review; all but one focussing solely on postnatal depression in mothers. Interventions included prevention (3/8), treatment (3/8) or identification plus treatment (2/8). Two interventions were likely to be cost-effective, both incorporated identification plus treatment. Where the cost per quality-adjusted life year (QALY) gained was reported, interventions ranged from being dominant (cheaper and more effective than usual care) to costing £39 875/QALY.ConclusionsUncertainty and heterogeneity across studies in terms of setting and design make it difficult to make direct comparisons or draw strong conclusions. However, the two interventions incorporating identification plus treatment of perinatal depression were both likely to be cost-effective. Many gaps were identified in the economic evidence, such as the cost-effectiveness of interventions for perinatal anxiety, antenatal depression or interventions for fathers.PROSPERO registration numberCRD42016051133.

Perinatal mental health: a review of progress and challenges

“…Recent systematic reviews provide robust evidence (>49 RCTs) that psychological and psychosocial interventions for postnatal depression are effective and cost‐effective 81,82 .…”

Economics and mental health: the current scenario

“…Perinatal mental health is a good illustration of the potential “spillover” and “external” effects, and thus the wider economic impacts, of treatment and care in mental health. A recent review on cost‐effectiveness of perinatal interventions for depression and/or anxiety looked at studies published between 2000 and 2017. All eight studies reviewed targeted depression in postnatal mothers, while only one study included anxiety and fathers in the evaluation.…”

“…Other economic evidence gaps in this area include perinatal anxiety, antenatal depression, and interventions for fathers, as well as interventions in lower‐resource settings. The latter is particularly needed, given that economic evidence generated in high‐income areas is often not applicable.…”

“…The latter is particularly needed, given that economic evidence generated in high‐income areas is often not applicable. For example, although screening‐plus‐treatment programmes were shown to be cost‐effective, this was based on evidence from high‐income countries.…”

Economic Evaluations of Public Health Interventions to Improve Mental Health and Prevent Suicidal Thoughts and Behaviours: A Systematic Literature Review

“…Despite the above observation, the use of economic evaluations in the field of mental health care generally continues to grow (Evers et al 2007 ). Some systematic reviews summarizing the economic impact of interventions designed to prevent mental disorders were recently published (Camacho and Shields 2018 ; Mihalopoulos and Chatterton 2015 ; Paganini et al 2018 ). The majority of the interventions included were implemented in the health care sector and targeted distinct diagnoses, such as depression and anxiety.…”