Title: Understanding the cost-effectiveness of identifying and treating perinatal depression (PND) using secondary data analysis
Funder: Department of Health and Social Care

Abstract: Perinatal depression (PND) occurs during pregnancy or the first year post-childbirth, affecting an estimated 120,000 women annually in England. It remains unidentified by healthcare professionals in 50% of cases. This is a barrier to accessing support. To maximise the sustainability of Specialist Perinatal Mental Health Services within the NHS, they must allocate their finite resources towards cost-effective treatments. This study will answer two important questions about the cost-effectiveness of identifying and treating PND. Question 1: Is selective screening for PND cost-effective? Universal screening for PND is not cost-effective. Some women are at higher risk of PND, therefore it is possible to target screening towards them. Our first aim is to estimate the cost-effectiveness of selective screening for PND. We will build a decision model to explore the costs and benefits of selectively screening high-risk women, using data from a completed observational study of PND in Northern England. Question 2: How can the Edinburgh Postnatal Depression Scale (EPDS) be used to estimate quality-adjusted life years (QALYs)? NICE assess the cost-effectiveness of healthcare treatments/services based on their cost to improve health by one QALY. Not many studies have collected data to evaluate the cost-effectiveness of PND treatments. In contrast, there is ample existing clinical effectiveness data collected using the EPDS. The cost-effectiveness evidence-base can be strengthened by learning how to estimate QALYs from the EPDS. This can be done by mapping between the EPDS and the EQ-5D (NICE s recommended tool for deriving QALYs). Our second aim is to generate a mapping algorithm between the EPDS and the EQ-5D. We will use data from 5 completed studies and follow current best-practice guidelines for mapping. By identifying cost-effective services for PND, more women will be enabled to access support, and services will be able to use their budget more effectively to help more families.

Lay abstract: One in five women experience depression during pregnancy or following their baby s birth. This is called perinatal depression (PND) and affects 120,000 women each year in England. Half of the time PND is undiagnosed which means women may not access help. This could lead to worse symptoms and an increased chance they will experience depression in future. We spoke to women who experienced PND and healthcare professionals to develop this project. They told us that identifying PND and accessing support were common problems. One way to identify women experiencing PND is to test everyone. This is called universal screening. However, this is not good value for money (i.e. cost-effective) because it is expensive and not the best way of getting help to those who need it most. Some women are at higher risk of developing PND than others, for example if they had depression previously. The first part of this project will explore whether screening high-risk women only is cost-effective. The NHS budget is limited, and decisions are made about which treatments provide good value for NHS money. Not much is known about this for PND treatments. The second part of this project will help the decision-makers learn more about the cost-effectiveness of treatments for PND. To answer these important questions, we will use data that has already been collected by other studies. This research aims to reduce the impact of PND for women, their babies, and other family members. If screening women at high-risk of PND is cost-effective, it could lead to better recognition of the condition. Being able to identify which treatments are cost-effective could also help improve access to care. We will work with the public, professionals, and organisations committed to improving maternal mental health, to ensure our findings are clear and useful to a broad audience.

Research activity codes: 4.4 POPULATION SCREENING;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH;REPRODUCTIVE HEALTH AND CHILDBIRTH