Cost-effectiveness of a group psychological intervention for postnatal depression in British South Asian mothers: an economic evaluation from the ROSHNI-2 trial
<p><strong>Background:</strong> Ethnic minorities often face ethnocultural barriers in accessing mental health treatments. The ROSHNI-2 trial compared culturally adapted cognitive behavioural therapy (Positive Health Programme, PHP) with treatment as usual (TAU) for postnatal depre...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2025
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| _version_ | 1824459217493295104 |
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| author | Ullah, A Lunat, F Brugha, T Pierce, M Morriss, R Sharma, D Rahman, A Bhui, K Bower, P Husain, N |
| author_facet | Ullah, A Lunat, F Brugha, T Pierce, M Morriss, R Sharma, D Rahman, A Bhui, K Bower, P Husain, N |
| author_sort | Ullah, A |
| collection | OXFORD |
| description | <p><strong>Background:</strong> Ethnic minorities often face ethnocultural barriers in accessing mental health treatments. The ROSHNI-2 trial compared culturally adapted cognitive behavioural therapy (Positive Health Programme, PHP) with treatment as usual (TAU) for postnatal depression in South Asian women. This study presents a health economic evaluation of the PHP intervention.</p>
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<p><strong>Methods:</strong> A total of 732 British South Asian women with depression were randomised (1:1), stratified by centre, into PHP plus TAU and TAU-only groups. The EuroQol 5-dimensional instrument was used for cost-utility analysis, while recovery from depression using the Hamilton Rating Scale for Depression was used for cost-effectiveness analysis.</p>
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<p><strong>Outcomes:</strong> The base-case intention-to-treat analysis showed PHP significantly increased costs (£912, 95% CI £420–£1405) and quality-adjusted life years (QALYs) (0.037, CI 0.006–0.068), with an incremental
cost-effectiveness ratio (ICER) of £24,739 (CI £15,539–£39,692). Based on NICE's maximum willingness-to-pay (WTP) threshold of £30,000 per QALY, the likelihood of PHP being cost-effective was 63% from a health and social care perspective. Cost per remission from depression at the 4-month follow-up was £5,354 (CI £3,878–£7,189). In a stratified analysis of 34 participants attending online sessions during the pandemic, incremental QALY effects were 0.134 (CI 0.073–0.194), resulting in costs of £397 (CI £-2,492–£3,339) per additional QALY gained.</p>
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<p><strong>Interpretation:</strong> The cost of PHP intervention for postpartum mothers falls within NICE's range of £20,000–£30,000 per QALY, excluding benefits to the child or potential gains like reduced lost productivity from early remission. With each episode of perinatal depression in the UK estimated to have a lifetime cost of £75,000 for the mother and child, and considering the cultural and linguistic needs of ethnic minorities, PHP may be a cost-effective intervention for postnatal depression in minority women. Online PHP delivery has shown promising clinical and cost-effective results for this group but requires further large-scale study.</p>
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<p><strong>Funding:</strong> UK National Institute for Health and Care Research – 14/68/08.</p>
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<p><strong>Trial number:</strong> ISRCTN10697380.</p> |
| first_indexed | 2025-02-19T04:38:17Z |
| format | Journal article |
| id | oxford-uuid:a85c025c-ef31-4dd8-973a-89817e65bfb1 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2025-02-19T04:38:17Z |
| publishDate | 2025 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:a85c025c-ef31-4dd8-973a-89817e65bfb12025-02-07T13:26:29ZCost-effectiveness of a group psychological intervention for postnatal depression in British South Asian mothers: an economic evaluation from the ROSHNI-2 trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a85c025c-ef31-4dd8-973a-89817e65bfb1EnglishSymplectic ElementsElsevier2025Ullah, ALunat, FBrugha, TPierce, MMorriss, RSharma, DRahman, ABhui, KBower, PHusain, N<p><strong>Background:</strong> Ethnic minorities often face ethnocultural barriers in accessing mental health treatments. The ROSHNI-2 trial compared culturally adapted cognitive behavioural therapy (Positive Health Programme, PHP) with treatment as usual (TAU) for postnatal depression in South Asian women. This study presents a health economic evaluation of the PHP intervention.</p> <br> <p><strong>Methods:</strong> A total of 732 British South Asian women with depression were randomised (1:1), stratified by centre, into PHP plus TAU and TAU-only groups. The EuroQol 5-dimensional instrument was used for cost-utility analysis, while recovery from depression using the Hamilton Rating Scale for Depression was used for cost-effectiveness analysis.</p> <br> <p><strong>Outcomes:</strong> The base-case intention-to-treat analysis showed PHP significantly increased costs (£912, 95% CI £420–£1405) and quality-adjusted life years (QALYs) (0.037, CI 0.006–0.068), with an incremental cost-effectiveness ratio (ICER) of £24,739 (CI £15,539–£39,692). Based on NICE's maximum willingness-to-pay (WTP) threshold of £30,000 per QALY, the likelihood of PHP being cost-effective was 63% from a health and social care perspective. Cost per remission from depression at the 4-month follow-up was £5,354 (CI £3,878–£7,189). In a stratified analysis of 34 participants attending online sessions during the pandemic, incremental QALY effects were 0.134 (CI 0.073–0.194), resulting in costs of £397 (CI £-2,492–£3,339) per additional QALY gained.</p> <br> <p><strong>Interpretation:</strong> The cost of PHP intervention for postpartum mothers falls within NICE's range of £20,000–£30,000 per QALY, excluding benefits to the child or potential gains like reduced lost productivity from early remission. With each episode of perinatal depression in the UK estimated to have a lifetime cost of £75,000 for the mother and child, and considering the cultural and linguistic needs of ethnic minorities, PHP may be a cost-effective intervention for postnatal depression in minority women. Online PHP delivery has shown promising clinical and cost-effective results for this group but requires further large-scale study.</p> <br> <p><strong>Funding:</strong> UK National Institute for Health and Care Research – 14/68/08.</p> <br> <p><strong>Trial number:</strong> ISRCTN10697380.</p> |
| spellingShingle | Ullah, A Lunat, F Brugha, T Pierce, M Morriss, R Sharma, D Rahman, A Bhui, K Bower, P Husain, N Cost-effectiveness of a group psychological intervention for postnatal depression in British South Asian mothers: an economic evaluation from the ROSHNI-2 trial |
| title | Cost-effectiveness of a group psychological intervention for postnatal depression in British South Asian mothers: an economic evaluation from the ROSHNI-2 trial |
| title_full | Cost-effectiveness of a group psychological intervention for postnatal depression in British South Asian mothers: an economic evaluation from the ROSHNI-2 trial |
| title_fullStr | Cost-effectiveness of a group psychological intervention for postnatal depression in British South Asian mothers: an economic evaluation from the ROSHNI-2 trial |
| title_full_unstemmed | Cost-effectiveness of a group psychological intervention for postnatal depression in British South Asian mothers: an economic evaluation from the ROSHNI-2 trial |
| title_short | Cost-effectiveness of a group psychological intervention for postnatal depression in British South Asian mothers: an economic evaluation from the ROSHNI-2 trial |
| title_sort | cost effectiveness of a group psychological intervention for postnatal depression in british south asian mothers an economic evaluation from the roshni 2 trial |
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