Routine Screening for Postnatal Depression Not Cost-Effective

Caroline Cassels

December 30, 2009

December 30, 2009 — Routine screening for postnatal depression in primary care, as recommended by recent UK guidelines, does not appear to be cost-effective, a new British study suggests.

According to research published online December 22 in the British Medical Journal, such screening does not represent value for money for the UK's National Health Service, primarily because of the cost of managing patients misdiagnosed with depression.

"Postnatal depression is an important clinical, economic, and social problem which is under-recognized and for which effective treatments are available. Decisions to screen, however, have attracted considerable controversy, and such policy decision should be informed by systematic consideration of the clinical and economic evidence," principal investigator Simon Gilbody, MBChB, MSc, MRCPsych, professor of psychological medicine and health services research, University of York, United Kingdom, and colleagues write.

It is estimated that more than 11% of women experience major or minor postnatal depression 6 weeks after giving birth. According to the study, evidence shows that postnatal depression has a major effect on the mother, her partner, the family, and mother–baby interactions, as well as the long-term emotional and cognitive development of the baby, especially when maternal depression occurs in the first year of life.

Formal identification methods, such as postnatal or general depression questionnaires, have been advocated. Further, recent clinical guidelines issued by the National Institute for Health and Clinical Excellence, a UK advisory agency to the National Health Service, recommend the use of brief case-finding questions to identify possible postnatal depression with the use of self-report measures such as the Edinburgh Postnatal Depression Scale. However, the authors point out that the cost-effectiveness of such a strategy is uncertain.

Using a computer model to evaluate the cost-effectiveness of routine screening for postnatal depression in primary care, the investigators found that the routine application of either postnatal or general depression questionnaires did not seem to be cost-effective compared with routine care only.

For example, investigators found the Edinburgh Postnatal Depression Scale had an incremental cost effectiveness ratio of £41,103 per quality-adjusted life-year — a combined measure of quantity and quality of life — compared with routine care only.

The ratio for all other strategies ranged from £49,928 to £272,463 per quality-adjusted life-year compared with routine care only. In contrast, the strategy of administering only routine care was most likely to be cost-effective.

The authors have disclosed no relevant financial relationships.

BMJ. Published online December 22, 2009.

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