Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model
Abstract Background Although the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of di...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-08115-x |
| _version_ | 1818228285473030144 |
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| author | Margaret Heslin Huajie Jin Kylee Trevillion Xiaoxiao Ling Selina Nath Barbara Barrett Jill Demilew Elizabeth G. Ryan Sheila O’Connor Polly Sands Jeannette Milgrom Debra Bick Nicky Stanley Myra S. Hunter Louise M. Howard Sarah Byford |
| author_facet | Margaret Heslin Huajie Jin Kylee Trevillion Xiaoxiao Ling Selina Nath Barbara Barrett Jill Demilew Elizabeth G. Ryan Sheila O’Connor Polly Sands Jeannette Milgrom Debra Bick Nicky Stanley Myra S. Hunter Louise M. Howard Sarah Byford |
| author_sort | Margaret Heslin |
| collection | DOAJ |
| description | Abstract Background Although the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of different screening tools to identify depression in early pregnancy compared to no screening. Methods A decision tree was developed to model the identification and treatment pathways of depression from the first antenatal appointment to 3-months postpartum using the Whooley questions, the Edinburgh Postnatal Depression Scale (EPDS) and the Whooley questions followed by the EPDS, compared to no screening. The economic evaluation took an NHS and Personal Social Services perspective. Model parameters were taken from a combination of sources including a cross-sectional survey investigating the diagnostic accuracy of screening tools, and other published literature. Cost-effectiveness was assessed in terms of the incremental cost per quality adjusted life years (QALYs). Cost-effectiveness planes and cost-effectiveness acceptability curves were produced using a net-benefit approach based on Monte Carlo simulations of cost-outcome data. Results In a 4-way comparison, the Whooley, EPDS and Whooley followed by the EPDS each had a similar probability of being cost-effective at around 30% for willingness to pay values from £20,000–30,000 per QALY compared to around 20% for the no screen option. Conclusions All three screening approaches tested had a higher probability of being cost-effective than the no-screen option. In the absence of a clear cost-effectiveness advantage for any one of the three screening options, the choice between the screening approaches could be made on other grounds, such as clinical burden of the screening options. Limitations include data availability and short time horizon, thus further research is needed. Clinical trials registration N/A |
| first_indexed | 2024-12-12T10:00:17Z |
| format | Article |
| id | doaj.art-4e5144d60cb54f92a1f2a1ed6d1a9fea |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-12T10:00:17Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-4e5144d60cb54f92a1f2a1ed6d1a9fea2022-12-22T00:28:01ZengBMCBMC Health Services Research1472-69632022-06-0122111710.1186/s12913-022-08115-xCost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree modelMargaret Heslin0Huajie Jin1Kylee Trevillion2Xiaoxiao Ling3Selina Nath4Barbara Barrett5Jill Demilew6Elizabeth G. Ryan7Sheila O’Connor8Polly Sands9Jeannette Milgrom10Debra Bick11Nicky Stanley12Myra S. Hunter13Louise M. Howard14Sarah Byford15Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King’s College LondonHealth Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King’s College LondonHealth Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King’s College LondonDepartment of Statistical Science, University College LondonPopulation, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child HealthHealth Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King’s College LondonKing’s College Hospital NHS Foundation TrustCentre for Health Services Research, University of QueenslandKing’s College Hospital NHS Foundation TrustGuy’s and St Thomas’ NHS Foundation TrustParent-Infant Research Institute, Austin HealthWarwick Clinical Trials Unit, University of Warwick & University Hospitals Coventry and Warwick NHS Foundation TrustSchool of Social Work, Care and Community, University of Central LancashireDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King’s College LondonHealth Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King’s College LondonHealth Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King’s College LondonAbstract Background Although the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of different screening tools to identify depression in early pregnancy compared to no screening. Methods A decision tree was developed to model the identification and treatment pathways of depression from the first antenatal appointment to 3-months postpartum using the Whooley questions, the Edinburgh Postnatal Depression Scale (EPDS) and the Whooley questions followed by the EPDS, compared to no screening. The economic evaluation took an NHS and Personal Social Services perspective. Model parameters were taken from a combination of sources including a cross-sectional survey investigating the diagnostic accuracy of screening tools, and other published literature. Cost-effectiveness was assessed in terms of the incremental cost per quality adjusted life years (QALYs). Cost-effectiveness planes and cost-effectiveness acceptability curves were produced using a net-benefit approach based on Monte Carlo simulations of cost-outcome data. Results In a 4-way comparison, the Whooley, EPDS and Whooley followed by the EPDS each had a similar probability of being cost-effective at around 30% for willingness to pay values from £20,000–30,000 per QALY compared to around 20% for the no screen option. Conclusions All three screening approaches tested had a higher probability of being cost-effective than the no-screen option. In the absence of a clear cost-effectiveness advantage for any one of the three screening options, the choice between the screening approaches could be made on other grounds, such as clinical burden of the screening options. Limitations include data availability and short time horizon, thus further research is needed. Clinical trials registration N/Ahttps://doi.org/10.1186/s12913-022-08115-xCost-effectivenessDecision analytic modelDepressionPregnancyScreeningWhooley |
| spellingShingle | Margaret Heslin Huajie Jin Kylee Trevillion Xiaoxiao Ling Selina Nath Barbara Barrett Jill Demilew Elizabeth G. Ryan Sheila O’Connor Polly Sands Jeannette Milgrom Debra Bick Nicky Stanley Myra S. Hunter Louise M. Howard Sarah Byford Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model BMC Health Services Research Cost-effectiveness Decision analytic model Depression Pregnancy Screening Whooley |
| title | Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model |
| title_full | Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model |
| title_fullStr | Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model |
| title_full_unstemmed | Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model |
| title_short | Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model |
| title_sort | cost effectiveness of screening tools for identifying depression in early pregnancy a decision tree model |
| topic | Cost-effectiveness Decision analytic model Depression Pregnancy Screening Whooley |
| url | https://doi.org/10.1186/s12913-022-08115-x |
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