Department of Psychiatry, University of Washington, Seattle, WA, USA.
Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):9593-9599. doi: 10.1080/14767058.2022.2049746. Epub 2022 Mar 13.
The US Preventive Services Task Force recently recommended that clinicians refer all pregnant and postpartum individuals at increased risk of perinatal depression to a counseling intervention. Adolescents are considered a high-risk group for perinatal depression. Therefore, we examined whether it is cost effective for all pregnant adolescents to be referred for preventive counseling.
We developed a decision-analytic model using TreeAge Pro software to compare outcomes in pregnant adolescents who received versus did not receive counseling interventions. We used a theoretical cohort of 180,000 individuals, which is the estimated annual number of births to persons ≤ 19 years in the US. Outcomes included perinatal depression, chronic depression, maternal suicide attributed to depression, preterm delivery, neonatal death, cerebral palsy, and sudden infant death syndrome (SIDS), in addition to cost and quality-adjusted life years (QALYs). The willingness-to-pay (WTP) threshold was set to $100,000/QALY. We derived model inputs from the literature, and sensitivity analyses were used to assess robustness of the model.
A strategy of referral to counseling interventions was cost effective in our theoretical cohort, with 8935 fewer cases of perinatal depression, 1606 fewer cases of chronic depression, 166 fewer preterm deliveries, 4 fewer neonatal deaths, 1 fewer case of cerebral palsy, 20 fewer cases of SIDS. In total, there were 21,976 additional QALYs and cost savings of $223,549,872, making it the dominant strategy (better outcomes with lower costs). We found that counseling interventions remained cost saving until the annual direct and indirect cost of chronic, severe depression was set below $30,000, at which point it became cost effective (baseline input: $182,309).
We found it was cost effective to refer all pregnant adolescents for preventive counseling interventions. Clinicians should develop approaches to identify and refer pregnant adolescents for behavioral counseling to prevent perinatal depression.
美国预防服务工作组最近建议，临床医生应将所有患有围产期抑郁症风险增加的孕妇和产后个体转介给咨询干预。青少年被认为是围产期抑郁症的高风险群体。因此，我们研究了是否对所有怀孕的青少年进行预防性咨询转介具有成本效益。
我们使用 TreeAge Pro 软件开发了一种决策分析模型，以比较接受和未接受咨询干预的孕妇的结果。我们使用了一个理论队列，其中包含 18 万人，这是美国每年≤19 岁的人出生的估计人数。结果包括围产期抑郁症、慢性抑郁症、归因于抑郁的母亲自杀、早产、新生儿死亡、脑瘫和婴儿猝死综合征（SIDS），以及成本和质量调整生命年（QALYs）。意愿支付（WTP）阈值设定为 10 万美元/QALY。我们从文献中得出模型输入，并使用敏感性分析来评估模型的稳健性。
在我们的理论队列中，转诊咨询干预策略具有成本效益，围产期抑郁症减少了 8935 例，慢性抑郁症减少了 1606 例，早产减少了 166 例，新生儿死亡减少了 4 例，脑瘫减少了 1 例，婴儿猝死综合征减少了 20 例。总的来说，有 21976 个额外的 QALYs 和 223549872 美元的成本节约，使其成为主导策略（更好的结果和更低的成本）。我们发现，只要慢性、重度抑郁症的年度直接和间接成本低于 30000 美元，咨询干预就一直保持成本节约，此时它就具有成本效益（基线输入：182309 美元）。
我们发现将所有孕妇转介进行预防性咨询干预具有成本效益。临床医生应制定方法，识别并转介孕妇接受行为咨询，以预防围产期抑郁症。
