Wilkinson Andra, Anderson Seri, Wheeler Stephanie B
Child Trends, 7315 Wisconsin Ave, #1200w, Bethesda, MD, 20814, USA.
Department of Maternal and Child Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7445, Chapel Hill, NC, 27599-7445, USA.
Matern Child Health J. 2017 Apr;21(4):903-914. doi: 10.1007/s10995-016-2192-9.
Objectives Postpartum depression impacts 6.5-12.9% of U.S. women. Postpartum depression is associated with impaired bonding and development, marital discord, suicide, and infanticide. However, the current standard of care is to not screen women for postpartum depression. This study modeled the cost-effectiveness of physicians screening for and treating postpartum depression and psychosis in partnership with a psychiatrist. Methods This study follows a hypothetical cohort of 1000 pregnant women experiencing one live birth over a 2-year time horizon. We used a decision tree model to obtain the outcomes of screening for and treating postpartum depression and psychosis using the Edinburgh Postnatal Depression Scale. We use a Medicaid payer perspective because they cover approximately 50% of births in the U.S. The cost-effectiveness of the intervention is measured in cost per remission achieved and cost per quality-adjusted life-year (QALY) gained. We conducted both deterministic and probabilistic sensitivity analyses. Results Screening for and treating postpartum depression and psychosis produced 29 more healthy women at a cost of $943 per woman. The incremental cost-effectiveness ratios of the intervention branch compared to usual care were $13,857 per QALY gained (below the commonly accepted willingness to pay threshold of $50,000/QALY gained) and $10,182 per remission achieved. These results were robust in both the deterministic and probabilistic sensitivity analyses of input parameters. Conclusions for Practice Screening for and treating postpartum depression is a cost-effective intervention and should be considered as part of usual postnatal care, which aligns with the recently proposed recommendations from the U.S. Preventive Services Task Force.
目标 产后抑郁症影响着6.5%-12.9%的美国女性。产后抑郁症与母婴情感联结受损、发育问题、婚姻不和、自杀及杀婴行为有关。然而,当前的护理标准是不对女性进行产后抑郁症筛查。本研究模拟了医生与精神科医生合作筛查和治疗产后抑郁症及精神病的成本效益。方法 本研究追踪了一个假设队列,该队列由1000名在2年时间内经历一次活产的孕妇组成。我们使用决策树模型,通过爱丁堡产后抑郁量表来获取筛查和治疗产后抑郁症及精神病的结果。我们采用医疗补助支付方的视角,因为他们覆盖了美国约50%的分娩。干预措施的成本效益通过实现缓解的单位成本和每获得一个质量调整生命年(QALY)的成本来衡量。我们进行了确定性和概率性敏感性分析。结果 筛查和治疗产后抑郁症及精神病使健康女性数量增加了29名,每位女性的成本为943美元。与常规护理相比,干预分支的增量成本效益比为每获得一个QALY 13,857美元(低于普遍接受的每获得一个QALY支付意愿阈值50,000美元)以及每实现一次缓解10,182美元。在输入参数的确定性和概率性敏感性分析中,这些结果都很稳健。实践结论 筛查和治疗产后抑郁症是一种具有成本效益的干预措施,应被视为常规产后护理的一部分,这与美国预防服务工作组最近提出的建议一致。
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