Cost-utility analysis of screening and cognitive behavioral therapy compared to usual care for postpartum depression

Abstract

Background: Postpartum depression is common and leads to an increase in the risk of poorer maternal outcomes and suicide. Implementing effective screening and treatment for postpartum depression is an international public health priority. Objective: This study aims to estimate the cost-effectiveness of implementing a strategy of Whooley screening followed by referral to Cognitive Behavioral Therapy (CBT) for women screened positive compared with the current Treatment as Usual (TAU) for women with postpartum depression in Hong Kong. Methods: A decision tree model was constructed to estimate the potential cost and utility benefits for Whooley screening followed by referral to CBT for women screened positive compared to TAU 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 (no depression/remission, and depression) modeled over the postpartum period. Deterministic, probabilistic sensitivity analyses and scenario analyses were conducted to explore the robustness of the results under the uncertainty around the model input parameters. Results: The base-case analysis suggested that Whooley screening followed by referral to CBT for women screened positive yielded an additional 0.014 QALYs compared to TAU and added HKD3193.15 to the cost per patient. Deterministic sensitivity analysis indicated that cost-effectiveness results were robust to utilities associated with depression, utilities associated with no depression/remission, and the probability of no improvement in depression for CBT. Probabilistic sensitivity analysis showed that Whooley screening followed by referral to CBT for women screened positive had a 100% likelihood of being more cost-effective than TAU at a willingness-to-pay (WTP) threshold of HKD422,191/QALY. Scenario analysis showed the important influence of patients’ acceptability and adherence to CBT on outcomes and revealed the impact of subsequent treatment costs on model results after considering subsequent treatment of false negative patients. Conclusions: Whooley screening followed by referral to CBT for women screened positive is estimated to be cost-effective in identifying and treating women with postpartum depression at an early stage compared to TAU. More research is required to assess this strategy’s feasibility, cost-benefit, and clinical effectiveness.