Understanding the economic value of interventions that address perinatal mental health problems: Literature review and methodological considerations.

Abstract

Objective: Economic evaluations of mental health problems typically only include short-term measures from an individual healthcare perspective. In perinatal mental health, which spans generations, this is likely to lead to an underestimation of interventions' potential benefits. We sought to understand the spectrum of outcomes of perinatal mental health problems that have economic consequences and how they are captured in economic evaluations.

Methods: We conducted a systematic search of the peer-reviewed literature to identify two types of evidence: (i) synthesised evidence (i.e. systematic reviews, meta-analyses) or recent cohort studies that measured the outcomes of perinatal mental health problems, (ii) economic evaluations. After presenting the evidence narratively, we derive an overview of different types of outcomes to include in economic evaluations.

Results: Evidence on the many, wide ranging adverse outcomes with short- and long-term economic consequences is rich, ranging from those that can be measured during the perinatal period (e.g., mother's employment), those that require a longer-term follow-up period (e.g., children's mental health service use) and those that can be used as predictors in modelling studies (e.g., birth weight). Only a small subset of economic consequences, and their predictors (e.g., child maltreatment, poor attachment), are currently measured in economic evaluations. We make some recommendations how more and new types of economic evaluations might start addressing the gap in knowledge.

Conclusions: To inform decisions about reducing the costs of perinatal mental health problems, economic evaluations that provide knowledge of interventions' abilities to reduce the short- and long-term economic consequences are urgently needed.