Cost-Effectiveness of Perinatal Depression Screening: A Scoping Review.

Abstract

Perinatal depression (PND) has emerged as a significant public health concern. There is no consensus among countries or organizations on whether to screen for PND. Despite the growing body of evidence regarding the economic value of PND screening, its cost-effectiveness remains inadequately understood due to the heterogeneity of existing studies. This study aims to synthesize the available global evidence on the cost-effectiveness of PND screening compared to routine or usual care to provide a clearer understanding of its economic value. A detailed search strategy was predetermined to identify peer-reviewed publications that evaluated the cost-effectiveness of PND screening. We designed a scoping literature review protocol and searched electronic databases, including MEDLINE, EMBASE, and Web of Science, for studies published from inception to 10 December 2023. We included studies that conducted full economic evaluations comparing PND screening with usual care or other comparators and excluded studies that were not in English or lacked full texts. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to evaluate the reporting quality of the studies. Then, the data regarding costs and effectiveness were extracted and summarized narratively. A total of ten eligible studies were included, all of which were evaluated as being of high reporting quality. Nine of these studies compared the economic value of PND screening with usual care without screening, with eight finding that PND screening was generally more cost-effective. The remaining study evaluated the cost-effectiveness of two psychosocial assessment models and indicated that both effectively identified women "at risk". Across studies, PND screening ranged from being dominant (cheaper and more effective than usual care without screening) to costing USD 17,644 per quality adjusted life year (QALY) gained. Most included studies used decision trees or Markov models to test if PND screening was cost-effective. Although current economic evaluation studies have mostly suggested PND screening could be more cost-effective than usual care without screening, there is high heterogeneity in terms of participants, screening strategies, screening settings, and perspectives across studies. Despite varied settings and designs, most studies consistently indicate PND screening as cost-effective. Further evidence is also required from low- and middle-income countries (LMIC), non-Western countries, and randomized controlled trials (RCTs) to draw a more robust conclusion.