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Title: Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model.
Austin Authors: 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;Byford, Sarah
Affiliation: Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia..
Parent-Infant Research Institute
Centre for Health Services Research, University of Queensland, Brisbane, Australia..
Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK..
Department of Statistical Science, University College London, London, UK..
Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK..
King's College Hospital NHS Foundation Trust, London, UK..
Guy's and St Thomas' NHS Foundation Trust, London, UK..
Warwick Clinical Trials Unit, University of Warwick & University Hospitals Coventry and Warwick NHS Foundation Trust, Coventry, UK..
School of Social Work, Care and Community, University of Central Lancashire, Preston, UK..
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College London, Guy's Campus, London, SE1 9RT, UK..
Issue Date: 13-Jun-2022 2022
Publication information: BMC health services research 2022; 22(1): 774
Abstract: 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. 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. 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. 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. N/A.
DOI: 10.1186/s12913-022-08115-x
ORCID: 0000-0002-4082-4595
Journal: BMC health services research
PubMed URL: 35698125
PubMed URL:
Type: Journal Article
Subjects: Cost-effectiveness
Decision analytic model
Appears in Collections:Journal articles

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