Cost-utility of public health nurse-delivered group cognitive behavioural therapy for postpartum depression

Abstract

Background

Postpartum depression (PPD) is associated with an increased risk of adverse outcomes for birthing parents, their children, and healthcare systems. Public health nurse (PHN)-delivered group cognitive behavioural therapy (CBT) can effectively treat PPD and has potential to be scaled, but its cost-effectiveness remains unknown. The purpose of this study was to examine the cost-utility of a PHN-delivered group CBT intervention for treating PPD added to treatment as usual (TAU) compared to TAU alone.

Methods

This economic evaluation was conducted alongside an RCT in Ontario, Canada. Birthing parents ≥18 years old with an infant ≤12 months and an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 were randomly assigned to receive PHN-delivered group CBT plus TAU or TAU alone. Costs were calculated based on healthcare service use over the 35-week trial period. The EQ-5D-3L was collected at baseline, 9 weeks, and 6 months later and used to calculate quality adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was calculated. Non-parametric bootstrapping was used to estimate uncertainty and generate a cost-effectiveness acceptability curve (CEAC).

Results

The intervention was associated with a 0.023 (95 % CI -0.058, 0.011) QALY gain and mean additional cost of $238 (95 % CI -$1749, $2227) compared to the control group. The ICER was $10,347 per QALY gained. At a willingness-to-pay of $50,000 for one QALY, PHN-delivered group CBT had a 75 % probability of being cost effective.

Conclusions

This trial-based cost-utility analysis found that PHN-delivered group CBT for treating PPD added to TAU may be cost-effective compared to TAU alone.