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Am J Perinatol
DOI: 10.1055/a-2708-5194
Original Article

Prospective Economic Evaluation Alongside the Telephone-Based Nurse-Delivered Interpersonal Psychotherapy for Postpartum Depression Trial

Authors

  • Susanne Hay

    1   Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
    2   Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts

  • Cindy-Lee Dennis

    3   Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada

  • Paula Ravitz

    4   Lunenfeld-Tanenbaum Research Institute and Sinai Health (Psychiatry), Toronto, Canada
    5   Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Toronto, Canada

  • Sophie Grigoriadis

    6   Department of Psychiatry, Sunnybrook Health Science Centre and Sunnybrook Research Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada

  • Elise Maddalone

    7   University of New England College of Osteopathic Medicine, Northeastern University, Boston, Massachusetts

  • Dmitry Dukhovny

    8   Division of Neonatology, Oregon Health and Science University, Portland, Oregon

  • John Zupancic

    1   Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
    2   Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Funding Information/Support Canadian Institutes of Health Research, grant number MCT 82332.
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Abstract

Objective

In a previously reported, multi-site, randomized controlled trial in women with postpartum depression (PPD), telephone-based, nurse-delivered, interpersonal psychotherapy (IPT) compared with standard postpartum care showed a reduction of 24% in the incidence of PPD (Dennis et al, British Journal of Psychiatry, 2020). The economic implications of this therapy have not been explored. We aimed to determine the cost-effectiveness of telephone-based, nurse-delivered IPT compared with standard postpartum care, using resource utilization data collected alongside the clinical study.

Study Design

We conducted a prospectively planned economic evaluation using patient-level data from the IPT trial, which enrolled 241 mothers with PPD. We considered costs from a societal perspective, measuring direct medical costs from study logs and secondary sources, as well as evaluating costs borne by the mother and family (including both medical and non-medical expenditures) and wage losses through questionnaires. We used a time horizon of 12 weeks post-randomization, corresponding to the endpoint of the clinical trial. Costs are reported in (2022) Canadian dollars.

Results

Patients in the IPT group had more phone calls with public health nurses external to those provided by the study protocol (IPT 73% versus control 55%, p = 0.007) and fewer visits to psychiatrists (9% versus 22%, p = 0.008). However, there were no statistically significant differences in any of the cost categories or total societal expenditures (IPT group $6,653, control group $5,336, p = 0.234). When costs and effects were combined, the societal expenditure was $5,397 for each additional patient without PPD.

Conclusion

Telephone-based, nurse-delivered IPT, as employed in this trial, showed no statistically significant differences in costs compared with standard care but resulted in improved clinical outcomes. Although associated with moderate uncertainty, the resulting incremental cost-effectiveness was well within the acceptable range for medical interventions in this population, and telephone-based, nurse-delivered IPT should be considered for patients with PPD.

Key Points

  • Telephone-based, nurse-delivered IPT is effective in treating PPD.

  • We performed an economic evaluation alongside a randomized controlled trial of IPT, using patient-level data and considering costs from a societal perspective.

  • Patients in the IPT group had more phone calls with public health nurses and fewer visits to psychiatrists, with overall similar costs between the two groups.

  • The societal expenditure was $5,397 for each additional patient without PPD, which is well within the acceptable range for medical interventions in this population.

  • Telephone-based, nurse-delivered IPT should be considered for cost-effective care of patients with PPD.

Keywords

costs and cost analysis - depression - postpartum - interpersonal psychotherapy - healthcare delivery

Contributions' Statement

The following authors have made significant contributions as determined by the Uniform Requirements for Manuscripts Submitted to Biomedical Journals:


S.H.: performed and supervised data cleaning, performed and supervised analyses, drafted the initial manuscript, received input from the authors below as part of the manuscript revision, and reviewed and revised the manuscript; C.-L.D.: conducted the trial, collected the data, devised the protocol, designed the content of financial data collection instruments, and reviewed and revised the manuscript; P.R.: trained and supervised research therapists for the telephone IPT trial and reviewed and revised the manuscript; S.G.: contributed to the original protocol, trained and supervised research therapists for the telephone IPT trial, and reviewed and revised the manuscript; E.M.: performed data cleaning, drafted the initial manuscript, and reviewed and revised the manuscript; D.D.: devised the protocol, designed the content of financial data collection instruments, and reviewed and revised the manuscript; J.Z.: devised the protocol, designed the content of financial data collection instruments, supervised and coordinated data collection, performed and supervised analyses, and reviewed and revised the manuscript. All the authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.


Supplementary Material



Publication History

Received: 09 January 2025

Accepted: 23 September 2025

Article published online:
09 October 2025

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