Article Text
Abstract
Objectives Postnatal maternal mental health problems, including depression and anxiety, entail a significant burden globally, and finding cost-effective preventive solutions is a public policy priority. This paper presents a cost-effectiveness analysis of the intervention, What Were We Thinking (WWWT), for the prevention of postnatal maternal mental health problems.
Design The economic evaluation, including cost-effectiveness and cost-utility analyses, was conducted alongside a cluster-randomised trial.
Setting 48 Maternal and Child Health Centres in Victoria, Australia.
Participants Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres. Full data were collected for 175 participants in the control arm and 184 in the intervention arm.
Intervention WWWT is a psychoeducational intervention targeted at the partner relationship, management of infant behaviour and parental fatigue.
Outcome measures The evaluation considered public sector plus participant out-of-pocket costs, while outcomes were expressed in the 30-day prevalence of depression, anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic, prognostic and clinical characteristics.
Results The intervention was estimated to cost $A118.16 per participant. The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes. The incremental cost-effectiveness ratios were $A36 451 per QALY gained and $A152 per percentage-point reduction in 30-day prevalence of depression, anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness threshold of $A55 000 per QALY; however, there was considerable uncertainty surrounding the results, with a 55% probability that WWWT would be considered cost-effective at that threshold.
Conclusions The results suggest that, although WWWT shows promise as a preventive intervention for postnatal maternal mental health problems, further research is required to reduce the uncertainty over its cost-effectiveness as there were no statistically significant differences in costs or outcomes.
Trial registration number ACTRN12613000506796; results.
- Postnatal depression
- Prevention
- Economic evaluation
- Cost-effectiveness
- MENTAL HEALTH
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors JR, PL, TT, KW, HR and JF contributed to the design of the economic evaluation, interpretation of results and approval of the final paper; JR and PL undertook the data analyses and prepared the manuscript; JF and HR developed the WWWT intervention.
Funding This study was funded by competitively awarded grants from the National Health and Medical Research Council (APP1026550), the Australian Government Department of Social Services (formerly Families, Housing, Community Services and Indigenous Affairs) and the Victorian Department of Education and Early Childhood Development.
Competing interests None declared.
Ethics approval Southern Health (now Monash Health) Human Research Ethics Committee, also the Education and Policy Research Committee, Victorian Government Department of Education and Early Childhood Development (now Department of Education and Training) and the study was registered with the Monash University Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.