Identifying and assessing the benefits of interventions for postnatal depression: a systematic review of economic evaluations

Abstract

Background: Economic evaluations of interventions for postnatal depression (PND) are essential to ensure optimal healthcare decision-making. Due to the wide-ranging effects of PND on the mother, baby and whole family, there is a need to include outcomes for all those affected and to include health and non-health outcomes for accurate estimates of cost-effectiveness. This study aimed to identify interventions to prevent or treat PND for which an economic evaluation had been conducted and to evaluate the health and non-health outcomes included.

Methods: A systematic review was conducted applying a comprehensive search strategy across eight electronic databases and other sources. Full or partial economic evaluations of interventions involving preventive strategies (including screening), and any treatments for women with or at-risk of PND, conducted in OECD countries were included. We excluded epidemiological studies and those focussing on costs only. The included studies underwent a quality appraisal to inform the analysis.

Results: Seventeen economic evaluations met the inclusion criteria, the majority focused on psychological /psychosocial interventions. The interventions ranged from additional support from health professionals, peer support, to combined screening and treatment strategies. Maternal health outcomes were measured in all studies; however child health outcomes were included in only four of them. Across studies, the maternal health outcomes included were quality-adjusted-life-years gained, improvement in depressive symptoms, PND cases detected or recovered, whereas the child health outcomes included were cognitive functioning, depression, sleep and temperament. Non-health outcomes such as couples' relationships and parent-infant interaction were rarely included. Other methodological issues such as limitations in the time horizon and perspective(s) adopted were identified, that were likely to result in imprecise estimates of benefits.

Conclusions: The exclusion of relevant health and non-health outcomes may mean that only a partial assessment of cost-effectiveness is undertaken, leading to sub-optimal resource allocation decisions. Future research should seek ways to expand the evaluative space of economic evaluations and explore approaches to integrate health and non-health outcomes for all individuals affected by this condition. There is a need to ensure that the time horizon adopted in studies is appropriate to allow true estimation of the long-term benefits and costs of PND interventions.

Keywords: Economic analysis; Non-health consequences; Outcomes for young children; Parental outcomes; Postpartum depression; QALYs.

Fig. 1

PRISMA flowchart showing the study selection process. Notes: Coding- Stage 1) A. The study involves a formal economic evaluation of PND interventions based on primary and/or secondary data (e.g. previously published studies or other sources); B. The study discusses economic aspects of PND interventions and contains relevant primary and/or secondary data; C. Unclear if the study falls under (A) or (B) but contains useful information; D. The study discusses economic aspects of PND interventions, but is neither (A) nor (B); E. The study is not relevant to the economic evaluation of PND interventions. Stage 2) 1. Full economic evaluation; 2. Partial economic evaluation; 3. Study that measured/valued outcomes of PND interventions but did not consider cost or cost-effectiveness; 4. Other, such as study estimating resource use and/or economic burden of PND and interventions; 5. Secondary study discussing methods or results of economic evaluation; 6. Incomplete economic evaluation of PND interventions (e.g. ongoing studies); 7. Not relevant to the economic evaluation of PND interventions. (See Additional file 2)