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Cost-effectiveness of screening tools for identifying depression in early pregnancy : a decision tree model
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Heslin, Margaret, Jin, Huajie, Trevillion, Kylee, Ling, Xiaoxiao, Nath, Selina, Barrett, Barbara, Demilew, Jill, Ryan, Elizabeth G., O’Connor, Sheila, Sands, Polly, Milgrom, Jeannette, Bick, Debra, Stanley, Nicky, Hunter, Myra S., Howard, Louise M. and Byford, Sarah (2022) Cost-effectiveness of screening tools for identifying depression in early pregnancy : a decision tree model. BMC Health Services Research, 22 (1). 774. doi:10.1186/s12913-022-08115-x
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WRAP-cost-effectiveness-screening-tools-identifying-depression-early-pregnancy-decision-tree-model-Bick-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1558Kb) | Preview |
Official URL: https://doi.org/10.1186/s12913-022-08115-x
Abstract
Background: Although the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of different screening tools to identify depression in early pregnancy compared to no screening. Methods: A decision tree was developed to model the identification and treatment pathways of depression from the first antenatal appointment to 3-months postpartum using the Whooley questions, the Edinburgh Postnatal Depression Scale (EPDS) and the Whooley questions followed by the EPDS, compared to no screening. The economic evaluation took an NHS and Personal Social Services perspective. Model parameters were taken from a combination of sources including a cross-sectional survey investigating the diagnostic accuracy of screening tools, and other published literature. Cost-effectiveness was assessed in terms of the incremental cost per quality adjusted life years (QALYs). Cost-effectiveness planes and cost-effectiveness acceptability curves were produced using a net-benefit approach based on Monte Carlo simulations of cost-outcome data. Results: In a 4-way comparison, the Whooley, EPDS and Whooley followed by the EPDS each had a similar probability of being cost-effective at around 30% for willingness to pay values from £20,000–30,000 per QALY compared to around 20% for the no screen option. Conclusions: All three screening approaches tested had a higher probability of being cost-effective than the no-screen option. In the absence of a clear cost-effectiveness advantage for any one of the three screening options, the choice between the screening approaches could be made on other grounds, such as clinical burden of the screening options. Limitations include data availability and short time horizon, thus further research is needed. Clinical trials registration: N/A
| Item Type: | Journal Article | |||||||||||||||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RG Gynecology and obstetrics |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | |||||||||||||||||||||
| Library of Congress Subject Headings (LCSH): | Pregnant women -- Mental health, Mental illness in pregnancy, Pregnant women -- Mental health -- Diagnosis -- Cost effectiveness , Depression, Mental -- Diagnosis , Pregnancy -- Psychological aspects, Medical screening -- Cost effectiveness | |||||||||||||||||||||
| Journal or Publication Title: | BMC Health Services Research | |||||||||||||||||||||
| Publisher: | Biomed central | |||||||||||||||||||||
| ISSN: | 1472-6963 | |||||||||||||||||||||
| Official Date: | 13 June 2022 | |||||||||||||||||||||
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| Volume: | 22 | |||||||||||||||||||||
| Number: | 1 | |||||||||||||||||||||
| Article Number: | 774 | |||||||||||||||||||||
| DOI: | 10.1186/s12913-022-08115-x | |||||||||||||||||||||
| Status: | Peer Reviewed | |||||||||||||||||||||
| Publication Status: | Published | |||||||||||||||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||||||||||||||
| Date of first compliant deposit: | 22 November 2022 | |||||||||||||||||||||
| Date of first compliant Open Access: | 22 November 2022 | |||||||||||||||||||||
| RIOXX Funder/Project Grant: |
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| Is Part Of: | 1 |
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