. 2018 Aug 10;8(8):e022022. doi: 10.1136/bmjopen-2018-022022

Table 3.

Cost-effectiveness results

Study	Interventions	Net benefit	Net cost	ICER, key conclusions and uncertainty
Boath et al ²⁸	Psychiatric day hospital vs routine primary care	14 more women recovered in the intervention group.	The intervention was £53 824 (p<0.001) more expensive than routine care.	£3843 per each additional recovery. The net cost is sensitive to inclusion primary care and medication costs, increasing to £56 865. *Possibly cost-effective*
Petrou et al ²⁹	Counselling and support from health visitors vs usual care	The intervention group depressed for 2.14 weeks fewer (over 18 months) than the control group—this was not statistically significant (p=0.41).	The intervention group costs were £189 higher, although this was not significant (95% CI −£843 to £1237).	£68 per month of depression avoided. Possibly, a small improvement in outcomes for a small cost. *Possibly cost-effective*
Morrell et al ³⁰	Screening and talking therapy (CBA or PCA) delivered by health visitor vs usual care	EPDS score at 6 months was 0.9 lower (p<0.001) for those randomised to an intervention group. QALY gain of 0.002 (95% CI −0.001 to 0.005) associated with the intervention.	There was a non-significant net-saving of £26 (95% CI −£100 to £47) for women in the intervention groups.	Improved outcomes with comparable costs. No ICER reported because of negative net cost. CBA appears to be more cost-effective than PCA. Subgroup analysis of ’at-risk' women: 6-month EPDS score 2.1 lower (p=0.002). Analysis of imputed data: QALY gain increased to 0.003 (95% CI 0.001 to 0.006) and net cost saving increased to £47 (95% CI −£68 to −£4), both reaching statistical significance (£15 666/QALY). *Highly likely to be cost-effective*
Stevenson et al ³¹	Group CBT vs usual care	Intervention associated with a QALY gain of 0.039 (PSA results).	£1568 net cost of providing gCBT (PSA results).	£39 875 per QALY gained. Intervention is not likely to be cost-effective at accepted thresholds. More research is needed to address the level of uncertainty. *Not likely to be cost-effective*
Dukhovny et al ³⁵	Telephone-based peer support vs usual care	0.1116 more cases of postnatal depression avoided at 12 weeks in the intervention group.	£755 net cost associated with intervention (p<0.001).	£6768 per case of postnatal depression avoided. The ICER is within the range of other postnatal depression interventions. *Possibly cost-effective*
Ride et al ³⁴	Psychoeducational programme vs usual care	Comparable outcomes both in terms of prevalence of mental health conditions (p=0.883) and QALYs (p=0.967).	£167 net cost associated with the intervention, although this was not statistically significant (p=0.333).	£21 987/QALY; £92 per %-point reduction in 30-day prevalence of postnatal mental health disorders. The probability the intervention if cost-effective is 0.55 at a willingness to pay threshold of A$ 55 000 (approximately £30 000–£35 000)—more research is needed to reduce uncertainty. Multiple imputation of missing data increased ICER to £27 042/QALY. *Possibly cost-effective*
Grote et al ³²	Collaborative care for depression vs usual care	More depression-free days over 18 months for the intervention group: with PTSD 68 days (95% CI 5 to 132); without PTSD 13 days (95% CI −72 to 99).	Significant net cost associated with the intervention: with PTSD £868 (95% CI £543 to £1192); without PTSD £772 (95% CI £473 to £1072).	If a depression-free day is valued at US$20 (approximately £13): with PTSD net benefit of £32; without PTSD net cost of £600. *Possibly cost-effective*
Wilkinson et al ³³	Psychiatrist-supported general practitioner screening and treating postpartum depression and psychosis	29 more healthy women in the intervention group, equating to a total of 21.43 additional QALYs over 2 years.	Total additional cost associated with the intervention £185 173.	£8642 per QALY gained, £6350 per remission achieved, £588 per additional healthy woman. *Likely to be cost-effective*

Currency conversion and inflation rates used are reported in online supplementary table S4.

CBA, cognitive behavioural approach; CBT, cognitive behavioural therapy; EPDS, Edinburgh Postnatal Depression Scale; PCA, person-centred approach; QALY, quality-adjusted life year; RCT, randomised controlled trial.