Screening for postnatal depression in primary care: cost effectiveness analysis

被引:91
作者
Paulden, Mike [1 ]
Palmer, Stephen [1 ]
Hewitt, Catherine [1 ]
Gilbody, Simon [1 ]
机构
[1] Univ York, Dept Hlth Sci, York YO10 5DD, N Yorkshire, England
来源
BMJ-BRITISH MEDICAL JOURNAL | 2009年 / 339卷
关键词
SPECIFICITY; IMPACT; METAANALYSIS; SENSITIVITY;
D O I
10.1136/bmj.b5203
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To evaluate the cost effectiveness of routine screening for postnatal depression in primary care. Design Cost effectiveness analysis with a decision model of alternative methods of screening for depression, including standardised postnatal depression and generic depression instruments. The performance of screening instruments was derived from a systematic review and bivariate meta-analysis at a range of instrument cut points; estimates of other relevant parameters were derived from literature sources and relevant databases. A decision tree considered the full treatment pathway from the possible onset of postnatal depression through identification, treatment, and possible relapse. Setting Primary care. Participants A hypothetical population of women assessed for postnatal depression either via routine care only or supplemented by use of formal identification methods six weeks postnatally, as recommended in recent guidelines. Main outcome measures Costs expressed in 2006-7 prices and impact on health outcomes expressed in terms of quality adjusted life years (QALYs). The time horizon of the analysis was one year. Results The routine application of either postnatal or general depression questionnaires did not seem to be cost effective compared with routine care only. The Edinburgh postnatal depression scale (at a cut point of 16) had an incremental cost effectiveness ratio (ICER) of 41 pound 103 ((sic)45 398, $67 130) per QALY compared with routine care only. The ICER for all other strategies ranged from 49 pound 928 to 272 pound 463 per QALY versus routine care only, while the probability that no formal identification strategy was cost effective was 88% (59%) at a cost effectiveness threshold of 20 pound 000 (30 pound 000) per QALY. While sensitivity analysis indicated that the cost of managing incorrectly identified depression (false positive result) was an important driver of the model, formal identification approaches did not seem to be cost effective at any feasible estimate of this cost. Conclusions Formal identification methods for postnatal depression do not seem to represent value for money for the NHS. The major determinant of cost effectiveness seems to be the potential additional costs of managing women incorrectly diagnosed as depressed. Formal identification methods for postnatal depression do not currently satisfy the National Screening Committee's criteria for the adoption of a screening strategy as part of national health policy.
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页数:8
相关论文
共 28 条
[1]   The interpretation of random-effects meta-analysis in decision models [J].
Ades, AE ;
Lu, G ;
Higgins, JPT .
MEDICAL DECISION MAKING, 2005, 25 (06) :646-654
[2]  
[Anonymous], 2021, IMPL WHOL GEN SEQ NE
[3]  
[Anonymous], 2006, Decision modelling for health economic evaluation
[4]  
[Anonymous], UNIT COSTS HLTH SOCI
[5]  
[Anonymous], 2008, Guide to the methods of technology appraisal
[6]  
[Anonymous], 2007, Antenatal and postnatal mental health: the NICE guideline on clinical management and service guidance
[7]   Effect of the addition of a "help" question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study [J].
Arroll, B ;
Goodyear-Smith, F ;
Kerse, N ;
Fishman, T ;
Gunn, J .
BRITISH MEDICAL JOURNAL, 2005, 331 (7521) :884-886A
[8]  
Boath E.H., 1998, J REPROD INFANT PSYC, V16, P199, DOI DOI 10.1080/02646839808404568
[9]   QALYs and mental health care [J].
Chisholm, D ;
Healey, A ;
Knapp, M .
SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY, 1997, 32 (02) :68-75
[10]   Bivariate meta-analysis of sensitivity and specificity with sparse data: a generalized linear mixed model approach [J].
Chu, Haitao ;
Cole, Stephen R. .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 2006, 59 (12) :1331-1332