Postnatal depression treatments are not cost effective, say York researchers

Dec 23 2009

Routine screening for postnatal depression in primary care - as recommended in recent guidance from the National Institute for Health and Clinical Excellence (NICE) - does not appear to represent value for money for the NHS, researchers at the University of York have concluded.

The results of a study by academics in the University's Department of Health Sciences, Hull York Medical School and the Centre for Health Economics suggest that both the NICE recommendation and widespread current practice should be reviewed. The research is published on bmj.com today.

More than one in 10 women suffer from postnatal depression six weeks after giving birth, yet fewer than half of cases are detected in routine clinical practice. Screening strategies using brief depression questionnaires have been advocated but have attracted substantial controversy.

Furthermore, guidelines issued by NICE in 2007 recommend the use of specific questions to identify possible postnatal depression, but the effectiveness and value for money of this strategy is uncertain.

The researchers at York used a computer model to evaluate the cost effectiveness of screening for postnatal depression in primary care.

The project was commissioned by the NHS Health Technology Assessment Programme; a body which investigates what works and what represents value for money in the NHS. The research was led by Professor Simon Gilbody and Dr Catherine Hewitt, of the Department of Health Sciences and Hull York Medical School (HYMS) together with leading health economists Mike Paulden and Stephen Palmer, of CHE.

Professor Simon Gilbody who led the project, said: "While postnatal depression is a very important condition, screening for this disorder with questionnaires was costly and wrongly identified many women as depressed, resulting in inappropriate care."

Screening for postnatal depression with one of the most widely used questionnaires, the Edinburgh Postnatal Depression Scale, had an incremental cost effectiveness ratio of £41,103 per quality adjusted life year or QALY (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 QALY compared with routine care only, well above the conventional NHS cost effectiveness threshold of £20-30,000 per QALY.

In contrast, the strategy of treating post natal depression without using screening as is current practice represented good value for money.

The York-based research team concluded: "These findings suggest that both the recent NICE guidance and widespread current practice do not result in value for money for the NHS, and do not satisfy the National Screening Committee's criteria for the adoption of a screening strategy as part of national health policy."

Professor Gilbody added that "Postnatal depression is very important, but screening doesn't seem to be the answer. GPs and health visitors should be vigilant to Post Natal Depression and be able offer high quality treatment when they are sure a woman needs care."

The York team call for further research to quantify the cost of incorrect diagnosis and the wider impact of postnatal depression treatment strategies on the quality of life of the mother and her family.

Source: University of York