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Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial.

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posted on 28.02.2019, 11:45 by C Henderson, S Dixon, A Bauer, M Knapp, CJ Morrell, P Slade, SJ Walters, T Brugha
BACKGROUND: There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal. METHODS: Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12). RESULTS: In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%). CONCLUSIONS: PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.

Funding

The PoNDER trial was funded by NHS Health Technology Assessment, England; CH and MK inputs to the design and economic analysis reported in this paper were funded by an NIHR Senior Investigator award to MK.

History

Citation

Psychological Medicine, 2018, pp. 1-11

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences

Version

VoR (Version of Record)

Published in

Psychological Medicine

Publisher

Cambridge University Press (CUP)

eissn

1469-8978

Acceptance date

02/07/2018

Copyright date

2018

Available date

28/02/2019

Publisher version

https://www.cambridge.org/core/journals/psychological-medicine/article/costeffectiveness-of-ponder-health-visitor-training-for-mothers-at-lower-risk-of-depression-findings-on-prevention-of-postnatal-depression-from-a-clusterrandomised-controlled-trial/1C4F73D3D1645B5A23F6D68B56FF3AB6

Notes

The supplementary material for this article can be found at https://doi.org/10.1017/S0033291718001940 Clinical trial registration number. ISRCTN92195776 (www.controlledtrials.com/ISRCTN92195776)

Language

en

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