An economic evaluation of targeted case-finding strategies for identifying postnatal depression: A model-based...

Area of Science:

• Health Economics
• Mental Health
• Public Health

Background:

• Postnatal depression (PND) affects many women, with half remaining unidentified in routine care.
• Risk factors for PND include a history of anxiety/depression, young maternal age, and adverse life events.

Purpose of the Study:

• To estimate the cost-effectiveness of identifying postnatal depression (PND) in women with identified risk factors.
• To compare targeted case-finding versus universal case-finding for PND.

Main Methods:

• A decision tree model was developed to assess one-year costs and health outcomes.
• Data on PND risk factors, prevalence, and case-finding instrument accuracy were derived from a postnatal women cohort.
• Model parameters were informed by literature and expert consultation.

Main Results:

• Over half of the cohort (57.8%) had at least one PND risk factor.
• The Edinburgh Postnatal Depression Scale (EPDS-10) with a cut-off of ≥10 was the most cost-effective case-finding tool.
• Universal case-finding yielded a greater health improvement and was more cost-effective (£2945/QALY gained) than targeted case-finding (£8146/QALY gained) or no case-finding.

Conclusions:

• Universal postnatal depression case-finding is the most cost-effective strategy.
• Targeted case-finding for women with risk factors is more cost-effective than no case-finding.
• While the model focused on the first year postpartum, broader and long-term impacts should also be considered.