DOI: 10.5281/zenodo.10533875
title: Exploring the return-on-investment for scaling screening and psychosocial treatment for women with common perinatal mental health problems in Malawi: Developing a cost-benefit-calculator tool

description: Abstract

This study sought to develop a user-friendly decision-making tool to explore country-specific estimates for costs and economic consequences of different options for scaling screening and psychosocial interventions for women with common perinatal mental health problems in Malawi. We developed a simple simulation model using a structure and parameter estimates that were established iteratively with experts, based on published trials, international databases and resources, statistical data, best practice guidance and intervention manuals. The model projects annual costs and returns to investment from 2022 to 2026. The study perspective is societal, including health expenditure and productivity losses. Outcomes in the form of health-related quality of life are measured in Disability Adjusted Life Years, which were converted into monetary values. Economic consequences include those that occur in the year in which the intervention takes place. Results suggest that the net benefit is relatively small at the beginning but increases over time as learning effects lead to a higher number of women being identified and receiving (cost‑)effective treatment. For a scenario in which screening is first provided by health professionals (such as midwives) and a second screening and the intervention are provided by trained and supervised volunteers to equal proportions in group and individual sessions, as well as in clinic versus community setting, total costs in 2022 amount to US$ 0.66 million and health benefits to US$ 0.36 million. Costs increase to US$ 1.03 million and health benefits to US$ 0.93 million in 2026. Net benefits increase from US$ 35,000 in 2022 to US$ 0.52 million in 2026, and return-on-investment ratios from 1.05 to 1.45. Results from sensitivity analysis suggest that positive net benefit results are highly sensitive to an increase in staff salaries. This study demonstrates the feasibility of developing an economic decision-making tool that can be used by local policy makers and influencers to inform investments in maternal mental health

 

Description of data set

Iteratively, information was gathered from desk-based searches and from talking to and exchanging emails with experts in the maternal health field to establish a model structure and the parameter values. This included the development of an information request form that presents a list of parameters, parameter values and details about how the values were estimated and the data sources. We collected information on: Intervention’s effectiveness; prevalence rates; population and birth estimates; proportion of women attending services; salaries and reimbursement rates for staff and volunteers; details about training, supervision, intervention delivery (e.g., frequency, duration); unit costs, and data needed to derive economic consequences (e.g. women’s income, health weights). Data were searched from the following sources: published randomised controlled trials and meta-analyses; WHO published guidance and intervention manual; international databases and resources (WHO-CHOICE, Global Burden of Disease Database; International Monetary Fund; United Nations Treasury, World Bank, Global Investment Framework for Women’s and Children’s Health). We consulted two groups of experts: one group included individuals with clinical, research or managerial expertise in funding, managing, delivering, or evaluating screening of common mental health problems and PSIs; the second group included individuals from the Malawi Government, Ministry of Health Reproductive Health Unit and Non-Communicable Disease Committee and Mental Health Unit. The first group of experts provided information from research and administrative data systems concerned with implementing and evaluating screening for maternal mental health and the delivery of interventions. The second group of experts from the Malawi Government provided information on unit costs for hospital use and workforce data, as well as information on how training and supervision might be delivered at scale. Individuals were identified by colleagues of this team based or part-time based in Malawi, which included a psychiatrist specialising in perinatal mental health (co-author RS) and the coordinator of the African Maternal Mental Health Alliance (co-author DN), an organisation concerned with disseminating information and evidence on perinatal mental health to policy makers and influencers, and the wider public.