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Table 3 Description of outcomes used in model-based economic evaluations

From: Identifying and assessing the benefits of interventions for postnatal depression: a systematic review of economic evaluations

Study (Year) Intervention Outcomes Outcomes other than maternal and health outcomes How was the outcome measured and/or valued? Source Key assumptions Outcomes acknowledged but excluded
Battye (2012) [30] Befriending service (telephone helpline and one-to-one support by trained ‘befriender’ volunteers) Short-term • Improvements in mental health • Increased awareness of PND and PND support • Increased coping ability Long-term • Reduced infants behavioural problems • Improved infants cognitive functioning • Family functioning improvement Healthcare professionals and volunteers outcomes also measured. Child, othersa and non-health Short Warwick-Edinburgh Mental Wellbeing Scale, qualitative interviews and evaluation form Questionnaires, qualitative interviews, monitoring data, and published studies Intervention benefits will sustain in the future with only 20% drop-off.
Bauer (2011) [42] Universal health visiting (postnatal screening using EPDS and treatment [CBT+ antidepressant]) • QALY Utilities for depression states derived from secondary sources. Bennett et al. [51] and Revicki and Wood [52] Without treatment, PND will sustain with a short-term resolution. Symptoms of moderate-to-severe PND are comparable to those of moderate-to-severe depression. Child and non-health; reasons for their non-inclusion not provided
Campbell (2008) [28] Routine screening programme (using PHQ-2) and treatments (antidepressants, psychological therapies or social support) according to severity of PND. • PND cases detected • PND cases resolved • QALY PHQ-2, Preference weights for QALYs derived from a secondary source. Secondary sources, Revicki and Wood [52] Normal utility six-weeks post-treatment in the treatment responders. Non-responders with mild/moderate depression recover within six months of its onset. PND will sustain in undetected cases and non-responders with severe depression. A linear deterioration or improvement between health states over time. Child and non-health; child outcomes could not be included due to lack of reliable data
Hewitt (2009) [36] Identification 1.EPDS 2. Beck Depression Inventory Treatments 1. Structured psychological therapy 2. Listening visit (Both with preceding additional care) • QALY Utility weights derived for QALYs from a secondary source. Effectiveness estimate from a systematic review and meta-analysis, utility values from Revicki and Wood [52] Non-responders to treatment and usual care would remain depressed until the model endpoint. Women enter the relevant treatment at 6 weeks postnatally. A linear deterioration or improvement between health states over time. Child and partner/family; these outcomes could not be included due to lack of reliable data
NCCMH (2014) [38] Identification 1. EPDS only 2. Whooley questions followed by EPDS 3. Whooley questions followed by PHQ-9 Treatment 1. Facilitated self-help based on CBT principles 2. Listening visits (Both in addition to standard postnatal care) Identification • QALY Treatment • QALY • PND cases improved and not relapsed EPDS, Whooley question, PHQ-9. Utility weights derived for QALYs from a secondary source. Effectiveness estimate from meta-analyses, utility values from Sapin and colleagues [53], experts opinion Identification False negative women could have spontaneous recovery or be identified in the GP follow-up and offered treatment. Only first-line treatments considered and relapse not modelled. Treatment Women who improve remain in the state or relapse until the model endpoint. A linear deterioration or improvement between health states over time. Child, partner/family and non-health; reasons for excluding non-health outcomes was the lack of relevant evidence
Stevenson (2010) [40] Group CBT • QALY Changes in EPDS scores were translated to changes in utility using secondary data. Data from Morrell et al. [37] Benefits would sustain over the 6-month period with linear decline afterwards to zero, a year after the treatment. Child and partner/family; reasons for their non-inclusion not provided
Taylor (2014) [34] Social support (e.g. advocacy, befriending) • Increased well-being • Increased chances of employment and higher earnings • Long-term beneficial children outcomes • Reduced use of health and social care services • Increased tax revenues • Volunteers benefits Child, othersa and non-health Hospital Anxiety and Depression Scale, analysis of a cohort study Experts, a range of secondary sources Benefits were estimated from an observational study and an RCT of similar service. Benefits for women and society inferred from experts and a range of published studies.
  1. CBT Cognitive Behavioural Therapy, EPDS Edinburgh Postnatal Depression Scale, NCCMH National Collaborating Centre for Mental Health, PHQ Patient Health Questionnaire, QALY Quality-adjusted-life-year, RCT Randomised Controlled Trial
  2. aOthers include partner/family, volunteers or healthcare professionals