Am J Perinatol 2013; 30(08): 631-642
DOI: 10.1055/s-0032-1331029
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prospective Economic Evaluation of a Peer Support Intervention for Prevention of Postpartum Depression among High-Risk Women in Ontario, Canada

Dmitry Dukhovny
1   Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts
2   Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Cindy-Lee Dennis
3   Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
4   Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
5   Women's College Research Institute, Toronto, Ontario, Canada
,
Ellen Hodnett
3   Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
,
Julie Weston
3   Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
,
Donna E. Stewart
4   Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
,
Wenyang Mao
2   Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
John A. F. Zupancic
1   Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts
2   Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

02 July 2012

11 July 2012

Publication Date:
02 January 2013 (online)

Abstract

Objective A previous multisite, randomized, controlled trial of peer support compared with usual care for prevention of postpartum depression demonstrated a reduction in depression symptoms at 12 weeks postbirth. Our objective was to determine the cost-effectiveness of this intervention.

Study Design Prospectively planned economic evaluation alongside the clinical trial to determine the cost per case of postpartum depression averted, using individual patient data (n = 610) and societal perspective. All costs were expressed in 2011 Canadian dollars.

Results The mean cost per woman was $4,497 in the peer support group and $3,380 in the usual care group (difference of $1,117, p < 0.0001). There was a 95% probability that the program would cost less than $20,196 per case of postpartum depression averted.

Conclusions Although this is a volunteer-based program, it results in a net cost to the health care system and society. However, this cost is within the range for other accepted interventions for this population.

 
  • References

  • 1 Dennis CL, Hodnett E. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev 2007; (4) CD006116
  • 2 O'Hara MW. Postpartum depression: what we know. J Clin Psychol 2009; 65: 1258-1269
  • 3 Goodman JH. Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. J Adv Nurs 2004; 45: 26-35
  • 4 Earls MF. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics 2010; 126: 1032-1039
  • 5 Sills MR, Shetterly S, Xu S, Magid D, Kempe A. Association between parental depression and children's health care use. Pediatrics 2007; 119: e829-e836
  • 6 Cox JL, Murray D, Chapman G. A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry 1993; 163: 27-31
  • 7 Dennis CL, Kingston D. A systematic review of telephone support for women during pregnancy and the early postpartum period. J Obstet Gynecol Neonatal Nurs 2008; 37: 301-314
  • 8 Dennis CL, Hodnett E, Kenton L , et al. Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ 2009; 338: a3064
  • 9 Russell LB. Completing costs: patients' time. Med Care 2009; 47 (7) (Suppl. 01) S89-S93
  • 10 Canadian Agency for Drugs and Technologies in Health; Guidelines for the Economic Evaluation of Health Technologies: Canada. 3rd ed. Ottawa, Canada: Canadian Agency for Drugs and Technologies in Health; 2006
  • 11 Siegel JE, Weinstein MC, Russell LB, Gold MR. Panel on Cost-Effectiveness in Health and Medicine. Recommendations for reporting cost-effectiveness analyses. JAMA 1996; 276: 1339-1341
  • 12 Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 1996; 276: 1253-1258
  • 13 Browne G. Health Service Utilization and Cost of Care Questionnaire. Hamilton, Ontario: Health and Social Service Utilization Research Unit, McMaster University; 2001
  • 14 CANSIM. Consumer Price Index for Canada. Available at: http://www.statcan.gc.ca/start-debut-eng.html . Accessed March 1, 2009
  • 15 Burton A, Billingham LJ, Bryan S. Cost-effectiveness in clinical trials: using multiple imputation to deal with incomplete cost data. Clin Trials 2007; 4: 154-161
  • 16 Lavori PW, Dawson R, Shera D. A multiple imputation strategy for clinical trials with truncation of patient data. Stat Med 1995; 14: 1913-1925
  • 17 Thompson SG, Nixon RM, Grieve R. Addressing the issues that arise in analysing multicentre cost data, with application to a multinational study. J Health Econ 2006; 25: 1015-1028
  • 18 Glick HA, Doshi JA, Sonnad SS, Polsky D. Economic Evaluation in Clinical Trials. New York, NY: Oxford Press; 2007
  • 19 Ramsey S, Willke R, Briggs A , et al. Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA Task Force report. Value Health 2005; 8: 521-533
  • 20 Fenwick E, O'Brien BJ, Briggs A. Cost-effectiveness acceptability curves—facts, fallacies and frequently asked questions. Health Econ 2004; 13: 405-415
  • 21 World Health Organization; The Global Burden of Disease: 2004 Update. Geneva, Switzerland: WHO Press; 2008
  • 22 Donohue JM, Pincus HA. Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics 2007; 25: 7-24
  • 23 Morrell CJ, Spiby H, Stewart P, Walters S, Morgan A. Costs and effectiveness of community postnatal support workers: randomised controlled trial. BMJ 2000; 321: 593-598
  • 24 Petrou S, Cooper P, Murray L, Davidson LL. Cost-effectiveness of a preventive counseling and support package for postnatal depression. Int J Technol Assess Health Care 2006; 22: 443-453
  • 25 Barilla D, Marshak HH, Anderson SE, Hopp JW. Postpartum follow-up: can psychosocial support reduce newborn readmissions?. MCN Am J Matern Child Nurs 2010; 35: 33-39
  • 26 Paulden M, Palmer S, Hewitt C, Gilbody S. Screening for postnatal depression in primary care: cost effectiveness analysis. BMJ 2009; 339: b5203
  • 27 Morrell CJ, Warner R, Slade P , et al. Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation. The PoNDER trial. Health Technol Assess 2009; 13: iii-iv , xi–xiii, 1–153
  • 28 Petrou S, Morrell J, Spiby H. Assessing the empirical validity of alternative multi-attribute utility measures in the maternity context. Health Qual Life Outcomes 2009; 7: 40
  • 29 Unützer J, Katon WJ, Russo J , et al. Willingness to pay for depression treatment in primary care. Psychiatr Serv 2003; 54: 340-345
  • 30 Murray L, Carothers AD. The validation of the Edinburgh Post-natal Depression Scale on a community sample. Br J Psychiatry 1990; 157: 288-290
  • 31 Ramchandani P, Stein A, Evans J, O'Connor TG. ALSPAC study team. Paternal depression in the postnatal period and child development: a prospective population study. Lancet 2005; 365: 2201-2205
  • 32 Petrou S, Cooper P, Murray L, Davidson LL. Economic costs of post-natal depression in a high-risk British cohort. Br J Psychiatry 2002; 181: 505-512
  • 33 Clarke PM, Fiebig DG, Gerdtham UG. Optimal recall length in survey design. J Health Econ 2008; 27: 1275-1284
  • 34 Tomeo CA, Rich-Edwards JW, Michels KB , et al. Reproducibility and validity of maternal recall of pregnancy-related events. Epidemiology 1999; 10: 774-777
  • 35 Newport DJ, Brennan PA, Green P , et al. Maternal depression and medication exposure during pregnancy: comparison of maternal retrospective recall to prospective documentation. BJOG 2008; 115: 681-688
  • 36 Collins CH, Zimmerman C, Howard LM. Refugee, asylum seeker, immigrant women and postnatal depression: rates and risk factors. Arch Women Ment Health 2011; 14: 3-11
  • 37 Dennis CL. Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Depression Scale?. J Affect Disord 2004; 78: 163-169
  • 38 Ontario Case Costing Initiative (OCCI). Available at: http://www.occp.com/ . Accessed March 1, 2009
  • 39 Browne GGA, Roberts J, Whittaker S, Wong M, Prica M. Approach to the measurement of costs (expenditures) when evaluating health and social programmes. In: Working Paper Series 01–4. Hamilton, Ontario: System Linked Research Unit, McMaster University; 2001
  • 40 Ontario Association of Social Workers (OASW). Recommended Hourly Rate for Social Work Services in Ontario. www.oasw.org Published January 2009. Accessed November 3, 2009.