Maximizing maternal health and value for money in postpartum depression screening: a cost-effectiveness analysis using the All Our Families cohort and administrative data in Alberta, Canada

Shainur Premji; Sheila W McDonald; Deborah A McNeil; Eldon Spackman

doi:10.1016/j.jad.2020.11.051

Maximizing maternal health and value for money in postpartum depression screening: a cost-effectiveness analysis using the All Our Families cohort and administrative data in Alberta, Canada

Shainur Premji, Sheila W McDonald, Deborah A McNeil, Eldon Spackman

Centre for Health Economics

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Postpartum depression (PPD) affects 10-15% of women, is costly and debilitating, yet often remains undiagnosed. Within Alberta, Canada, screening is conducted at public health well child clinics using the Edinburgh Postnatal Depression Scale. If screened high-risk, women are offered referral to their family physicians for follow up diagnosis and treatment.

METHODS: We developed a decision tree to estimate the cost-effectiveness of PPD screening versus not screening in Alberta over a two-year time horizon using a public healthcare payer perspective. Both the current practice (51% attending referral) and a scenario analysis (100% attending referral) are presented.

RESULTS: Current practice results suggest screening leads to an incremental cost-effectiveness ratio (ICER) of $17,644 USD per quality adjusted life year (QALY). At a population-level, this resulted in an annual 813 (11%) additional cases diagnosed, 120 additional QALYs gained, and an additional cost of $2.1 million relative to not screening. With 100% attending referral, the ICER fell to $13,908 per QALY, resulting in an annual 1997 (27%) additional cases diagnosed, 249 additional QALYs gained, and an additional cost of $3.5 million relative to not screening.

LIMITATIONS: We were unable to explore the cost-effectiveness of PPD screening versus not screening for secondary populations, including children.

CONCLUSIONS: The results suggest screening may be most valuable when participation and compliance are maximized, where all women screened high-risk attend referral. This leads to greater value for money and increased maternal health gains across the population. Collaboration among public health and primary care services is encouraged to improve outcomes.

Original language	English
Pages (from-to)	839-846
Number of pages	8
Journal	Journal of affective disorders
Volume	281
DOIs	https://doi.org/10.1016/j.jad.2020.11.051
Publication status	Published - 15 Feb 2021

Keywords

Alberta
Child
Cost-Benefit Analysis
Depression, Postpartum/diagnosis
Female
Humans
Maternal Health
Quality-Adjusted Life Years

Access to Document

10.1016/j.jad.2020.11.051

Cite this

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title = "Maximizing maternal health and value for money in postpartum depression screening: a cost-effectiveness analysis using the All Our Families cohort and administrative data in Alberta, Canada",

abstract = "BACKGROUND: Postpartum depression (PPD) affects 10-15% of women, is costly and debilitating, yet often remains undiagnosed. Within Alberta, Canada, screening is conducted at public health well child clinics using the Edinburgh Postnatal Depression Scale. If screened high-risk, women are offered referral to their family physicians for follow up diagnosis and treatment.METHODS: We developed a decision tree to estimate the cost-effectiveness of PPD screening versus not screening in Alberta over a two-year time horizon using a public healthcare payer perspective. Both the current practice (51% attending referral) and a scenario analysis (100% attending referral) are presented.RESULTS: Current practice results suggest screening leads to an incremental cost-effectiveness ratio (ICER) of $17,644 USD per quality adjusted life year (QALY). At a population-level, this resulted in an annual 813 (11%) additional cases diagnosed, 120 additional QALYs gained, and an additional cost of $2.1 million relative to not screening. With 100% attending referral, the ICER fell to $13,908 per QALY, resulting in an annual 1997 (27%) additional cases diagnosed, 249 additional QALYs gained, and an additional cost of $3.5 million relative to not screening.LIMITATIONS: We were unable to explore the cost-effectiveness of PPD screening versus not screening for secondary populations, including children.CONCLUSIONS: The results suggest screening may be most valuable when participation and compliance are maximized, where all women screened high-risk attend referral. This leads to greater value for money and increased maternal health gains across the population. Collaboration among public health and primary care services is encouraged to improve outcomes.",

keywords = "Alberta, Child, Cost-Benefit Analysis, Depression, Postpartum/diagnosis, Female, Humans, Maternal Health, Quality-Adjusted Life Years",

author = "Shainur Premji and McDonald, {Sheila W} and McNeil, {Deborah A} and Eldon Spackman",

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day = "15",

doi = "10.1016/j.jad.2020.11.051",

language = "English",

volume = "281",

pages = "839--846",

journal = "Journal of affective disorders",

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Maximizing maternal health and value for money in postpartum depression screening: a cost-effectiveness analysis using the All Our Families cohort and administrative data in Alberta, Canada. / Premji, Shainur; McDonald, Sheila W; McNeil, Deborah A et al.
In: Journal of affective disorders, Vol. 281, 15.02.2021, p. 839-846.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Maximizing maternal health and value for money in postpartum depression screening

T2 - a cost-effectiveness analysis using the All Our Families cohort and administrative data in Alberta, Canada

AU - Premji, Shainur

AU - McDonald, Sheila W

AU - McNeil, Deborah A

AU - Spackman, Eldon

PY - 2021/2/15

Y1 - 2021/2/15

N2 - BACKGROUND: Postpartum depression (PPD) affects 10-15% of women, is costly and debilitating, yet often remains undiagnosed. Within Alberta, Canada, screening is conducted at public health well child clinics using the Edinburgh Postnatal Depression Scale. If screened high-risk, women are offered referral to their family physicians for follow up diagnosis and treatment.METHODS: We developed a decision tree to estimate the cost-effectiveness of PPD screening versus not screening in Alberta over a two-year time horizon using a public healthcare payer perspective. Both the current practice (51% attending referral) and a scenario analysis (100% attending referral) are presented.RESULTS: Current practice results suggest screening leads to an incremental cost-effectiveness ratio (ICER) of $17,644 USD per quality adjusted life year (QALY). At a population-level, this resulted in an annual 813 (11%) additional cases diagnosed, 120 additional QALYs gained, and an additional cost of $2.1 million relative to not screening. With 100% attending referral, the ICER fell to $13,908 per QALY, resulting in an annual 1997 (27%) additional cases diagnosed, 249 additional QALYs gained, and an additional cost of $3.5 million relative to not screening.LIMITATIONS: We were unable to explore the cost-effectiveness of PPD screening versus not screening for secondary populations, including children.CONCLUSIONS: The results suggest screening may be most valuable when participation and compliance are maximized, where all women screened high-risk attend referral. This leads to greater value for money and increased maternal health gains across the population. Collaboration among public health and primary care services is encouraged to improve outcomes.

AB - BACKGROUND: Postpartum depression (PPD) affects 10-15% of women, is costly and debilitating, yet often remains undiagnosed. Within Alberta, Canada, screening is conducted at public health well child clinics using the Edinburgh Postnatal Depression Scale. If screened high-risk, women are offered referral to their family physicians for follow up diagnosis and treatment.METHODS: We developed a decision tree to estimate the cost-effectiveness of PPD screening versus not screening in Alberta over a two-year time horizon using a public healthcare payer perspective. Both the current practice (51% attending referral) and a scenario analysis (100% attending referral) are presented.RESULTS: Current practice results suggest screening leads to an incremental cost-effectiveness ratio (ICER) of $17,644 USD per quality adjusted life year (QALY). At a population-level, this resulted in an annual 813 (11%) additional cases diagnosed, 120 additional QALYs gained, and an additional cost of $2.1 million relative to not screening. With 100% attending referral, the ICER fell to $13,908 per QALY, resulting in an annual 1997 (27%) additional cases diagnosed, 249 additional QALYs gained, and an additional cost of $3.5 million relative to not screening.LIMITATIONS: We were unable to explore the cost-effectiveness of PPD screening versus not screening for secondary populations, including children.CONCLUSIONS: The results suggest screening may be most valuable when participation and compliance are maximized, where all women screened high-risk attend referral. This leads to greater value for money and increased maternal health gains across the population. Collaboration among public health and primary care services is encouraged to improve outcomes.

KW - Alberta

KW - Child

KW - Cost-Benefit Analysis

KW - Depression, Postpartum/diagnosis

KW - Female

KW - Humans

KW - Maternal Health

KW - Quality-Adjusted Life Years

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DO - 10.1016/j.jad.2020.11.051

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SN - 0165-0327

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JO - Journal of affective disorders

JF - Journal of affective disorders

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