Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial

• Published in: Psychological medicine Vol. 49; no. 8; pp. 1324 - 1334
• Main Authors: Henderson, Catherine, Dixon, Simon, Bauer, Annette, Knapp, Martin, Morrell, C. Jane, Slade, Pauline, Walters, Stephen J., Brugha, Traolach
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.06.2019
• Subjects: At risk populations; Behavior; Cluster Analysis; Cognitive ability; Cognitive aspects; Cognitive Behavioral Therapy; Cost analysis; Cost-Benefit Analysis; Depression, Postpartum - diagnosis; Depression, Postpartum - epidemiology; Depression, Postpartum - prevention & control; England; Evaluation; Female; Health status; Health visiting; Humans; Intervention; Mental depression; Mental disorders; Mothers; Nurses, Community Health - economics; Nurses, Community Health - education; Original; Original Articles; Postpartum depression; Prevention; Professional Role; Psychiatric Status Rating Scales; Psychological support; Quality adjusted life years; Quality of Life; Women; Womens health; England; health visitor; depression; Cost-effectiveness; perinatal; prevention
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291718001940

There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal. Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12). In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%). PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.