The Cost-Effectiveness Of Two Alternative Strategies For The Treatment Of Postnatal Depression
Elizabeth Boath & John Cox
Primary Care Sciences, Keele University, Keele, Staffordshire, England
A prospective cohort study was used to assess the cost-effectiveness of treating 30 women with postnatal depression at Charles Street Parent and Baby Day Unit (PBDU), a specialised psychiatric day hospital in Stoke-on-Trent, England, compared with 30 women treated using routine primary care (RPC) in Burton-upon-Trent, England. Clinical outcome, social and marital adjustment were assessed on three occasions, three months apart using the Clinical Interview Schedule (CIS), the Edinburgh Postnatal Depression Scale (EPDS), the Work Leisure and Family Life Questionnaire-Modified (WLFLQ-M) and the Dyadic Adjustment Scale (DAS). The direct and indirect costs of the two treatments, to both the National Health Service (NHS) and the women, were collated using NHS finance data, retrospective analysis of case notes and patient interviews. There was no significant difference between the two groups in the socio-demographic or clinical details at baseline. The PBDU was the more effective treatment for postnatal depression and at the 3 and 6 month assessment there was a significant difference between the two groups on the CIS, the EPDS and the WLFLQ-M. There was no significant difference in the DAS at any time point. Twenty-one women in the PBDU group were no longer depressed at 6 months compared with only seven women in the RPC group. The total cost for the PBDU group was £38,809 (mean=£1,294) and £10,032 (mean=£334) for the RPC group. The PBDU is more effective, but more expensive than RPC. The cost-effectiveness ratio (the difference in the costs of the two services divided by the difference in effectiveness) was equivocal and therefore a value judgement would be necessary to assess whether successfully treating a woman with postnatal depression is worth an additional £2,056. Issues of replication and efficiency of the PBDU will be discussed.