Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
Department of Statistical Science, University College London, London, UK.
BMC Health Serv Res. 2022 Jun 13;22(1):774. doi: 10.1186/s12913-022-08115-x.
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.
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.
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.
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.
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尽管已经研究了筛查工具在检测妊娠期间抑郁症方面的有效性，但关于其成本效益的证据有限。这对于向决策者提供全面信息至关重要。本研究旨在探讨不同筛查工具在识别早期妊娠期间抑郁症方面的成本效益，与不进行筛查相比。
使用 Whooly 问卷、爱丁堡产后抑郁量表 (EPDS) 和 Whooly 问卷后 EPDS，开发决策树模型来模拟从第一次产前预约到产后 3 个月的抑郁识别和治疗途径，与不筛查相比。经济评估采用国民保健制度和个人社会服务视角。模型参数来自包括横断面调查在内的多种来源，该调查研究了筛查工具的诊断准确性，以及其他已发表的文献。成本效益以每质量调整生命年 (QALY) 的增量成本来评估。使用基于成本-结果数据的蒙特卡罗模拟的净收益方法，生成成本效益平面和成本效益可接受性曲线。
在 4 种比较中，Whooly、EPDS 和 Whooly 随后进行 EPDS 的每种方法都具有相似的成本效益概率，在愿意支付 20,000-30,000 英镑/QALY 的情况下，每种方法的成本效益概率都在 30%左右，而不进行筛查的方法则为 20%左右。
测试的三种筛查方法都比不筛查方法更有可能具有成本效益。在没有任何一种筛查方法具有明确的成本效益优势的情况下，可以根据其他因素（例如筛查方法的临床负担）来选择筛查方法。局限性包括数据可用性和短期时间范围，因此需要进一步研究。
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