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Maternal and Child Health Journal

, Volume 21, Issue 4, pp 903–914 | Cite as

Screening for and Treating Postpartum Depression and Psychosis: A Cost-Effectiveness Analysis

  • Andra WilkinsonEmail author
  • Seri Anderson
  • Stephanie B. Wheeler
Article

Abstract

Objectives Postpartum depression impacts 6.5–12.9% of U.S. women. Postpartum depression is associated with impaired bonding and development, marital discord, suicide, and infanticide. However, the current standard of care is to not screen women for postpartum depression. This study modeled the cost-effectiveness of physicians screening for and treating postpartum depression and psychosis in partnership with a psychiatrist. Methods This study follows a hypothetical cohort of 1000 pregnant women experiencing one live birth over a 2-year time horizon. We used a decision tree model to obtain the outcomes of screening for and treating postpartum depression and psychosis using the Edinburgh Postnatal Depression Scale. We use a Medicaid payer perspective because they cover approximately 50% of births in the U.S. The cost-effectiveness of the intervention is measured in cost per remission achieved and cost per quality-adjusted life-year (QALY) gained. We conducted both deterministic and probabilistic sensitivity analyses. Results Screening for and treating postpartum depression and psychosis produced 29 more healthy women at a cost of $943 per woman. The incremental cost-effectiveness ratios of the intervention branch compared to usual care were $13,857 per QALY gained (below the commonly accepted willingness to pay threshold of $50,000/QALY gained) and $10,182 per remission achieved. These results were robust in both the deterministic and probabilistic sensitivity analyses of input parameters. Conclusions for Practice Screening for and treating postpartum depression is a cost-effective intervention and should be considered as part of usual postnatal care, which aligns with the recently proposed recommendations from the U.S. Preventive Services Task Force.

Keywords

Postpartum Depression Screening Cost-effectiveness 

Notes

Acknowledgements

The authors received assistance from a number of individuals in the course of this research; we would specifically like to thank Katie Wouk and Dr. Allison Stuebe for sharing their expertise. At the time of this research, AW was supported by a predoctoral Ruth L. Kirschtein National Research Service Award from the National Institute on Drug Abuse (F31 DA036961) and SL was supported by funding from the National MCH Workforce Development Center.

Supplementary material

10995_2016_2192_MOESM1_ESM.docx (33 kb)
Supplementary material 1 (DOCX 32 KB)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Andra Wilkinson
    • 1
    • 2
    Email author
  • Seri Anderson
    • 3
  • Stephanie B. Wheeler
    • 3
  1. 1.Child TrendsBethesdaUSA
  2. 2.Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of Health Policy and ManagementUniversity of North Carolina at Chapel HillChapel HillUSA

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