Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
BMC Psychiatry. 2023 Nov 8;23(1):817. doi: 10.1186/s12888-023-05318-2.
Perinatal depression affects an estimated 1 in 5 women in North America during the perinatal period, with annualized lifetime costs estimated at $20.6 billion CAD in Canada and over $45.9 billion USD in the US. Access to psychological treatments remains limited for most perinatal women suffering from depression and anxiety. Some barriers to effective care can be addressed through task-sharing to non-specialist providers and through telemedicine platforms. The cost-effectiveness of these strategies compared to traditional specialist and in-person models remains unknown. This protocol describes an economic evaluation of non-specialist providers and telemedicine, in comparison to specialist providers and in-person sessions within the ongoing Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial.
The economic evaluation will be undertaken alongside the SUMMIT trial. SUMMIT is a pragmatic, randomized, non-inferiority trial across five North American study sites (N = 1,226) of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a behavioural activation treatment for perinatal depressive and anxiety symptoms. The primary economic evaluation will be a cost-utility analysis. The outcome will be the incremental cost-effectiveness ratio, which will be expressed as the additional cost required to achieve an additional quality-adjusted life-year, as assessed by the EuroQol 5-Dimension 5-Level instrument. A secondary cost-effectiveness analysis will use participants' depressive symptom scores. A micro-costing analysis will be conducted to estimate the resources/costs required to implement and sustain the interventions; healthcare resource utilization will be captured via self-report. Data will be pooled and analysed using uniform price and utility weights to determine cost-utility across all trial sites. Secondary country-specific cost-utility and cost-effectiveness analyses will also be completed. Sensitivity analyses will be conducted, and cost-effectiveness acceptability-curves will be generated, in all instances.
Results of this study are expected to inform key decisions related to dissemination and scale up of evidence-based psychological interventions in Canada, the US, and possibly worldwide. There is potential impact on real-world practice by informing decision makers of the long-term savings to the larger healthcare setting in services to support perinatal women with common mental health conditions.
在北美，估计有 1/5 的女性在围产期会受到围产期抑郁的影响，加拿大的年化终生成本估计为 206 亿加元，而美国则超过 459 亿美元。大多数患有抑郁和焦虑的围产期妇女获得心理治疗的机会仍然有限。通过向非专业提供者和远程医疗平台分担任务，可以解决一些有效护理的障碍。与传统的专科医生和面对面模式相比，这些策略的成本效益尚不清楚。本方案描述了一项针对非专业提供者和远程医疗的经济评估，与正在进行的通过增加治疗机会来扩大孕产妇心理健康护理（SUMMIT）试验中的专科医生和面对面治疗的比较。
经济评估将与 SUMMIT 试验同时进行。SUMMIT 是一项在北美五个研究地点（N=1226）进行的实用、随机、非劣效性试验，比较了两种提供者（专科医生与非专科医生）和两种交付模式（远程医疗与面对面）对围产期抑郁和焦虑症状的行为激活治疗的等效性。主要的经济评估将是成本效用分析。结果将是增量成本效益比，它将表示为实现额外质量调整生命年所需的额外成本，这将通过欧洲五维健康量表 5 级工具来评估。次要的成本效益分析将使用参与者的抑郁症状评分。将进行微观成本分析，以估计实施和维持干预措施所需的资源/成本；通过自我报告来捕捉医疗保健资源的利用情况。将对数据进行汇总分析，使用统一的价格和效用权重来确定所有试验地点的成本效益。还将完成二次特定国家的成本效益和成本效果分析。在所有情况下都将进行敏感性分析，并生成成本效果可接受性曲线。
这项研究的结果预计将为加拿大、美国乃至全球传播和扩大基于证据的心理干预措施提供关键决策信息。通过向决策者表明在支持患有常见精神健康疾病的围产期妇女的服务方面，对更大的医疗保健系统的长期节省，这可能会对实际实践产生影响。
