Cost-effectiveness of Web-Based and Home-Based Postnatal Psychoeducational Interventions for First-time Mothers: Economic Evaluation Alongside Randomized Controlled Trial.

Qishi Zheng,Lixia Zhu,Nana Jiao,Luming Shi,Wenru Wang,Sally Wai-Chi Chan,Nan Luo,Honggu He,Yap Seng Chong,Yiong Huak Chan

doi:10.2196/25821

Abstract

BackgroundThe cost-effectiveness of interventions has attracted increasing interest among researchers. Although web-based and home-based psychoeducational interventions have been developed to improve first-time mothers’ postnatal health outcomes, very limited studies have reported their cost-effectiveness.ObjectiveThe aim of this study was to evaluate the cost-effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period.MethodsA randomized controlled 3-group pretest and posttest design was adopted, and cost-effectiveness analysis from the health care’s perspective was conducted. A total of 204 primiparas were recruited from a public tertiary hospital in Singapore from October 2016 to August 2017 who were randomly allocated to the web-based intervention (n=68), home-based intervention (n=68), or control (n=68) groups. Outcomes of maternal parental self-efficacy, social support, postnatal depression, anxiety, and health care resource utilization were measured using valid and reliable instruments at baseline and at 1 month, 3 months, and 6 months after childbirth. The generalized linear regression models on effectiveness and cost were used to assess the incremental cost-effectiveness ratios of the web-based and home-based intervention programs compared to routine care. Projections of cumulative cost over 5 years incurred by the 3 programs at various coverage levels (ie, 10%, 50%, and 100%) were also estimated.ResultsThe web-based intervention program dominated the other 2 programs (home-based program and routine care) with the least cost (adjusted costs of SGD 376.50, SGD 457.60, and SGD 417.90 for web-based, home-based, and control group, respectively; SGD 1=USD 0.75) and the best improvements in self-efficacy, social support, and psychological well-being. When considering the implementation of study programs over the next 5 years by multiplying the average cost per first-time mother by the estimated average number of first-time mothers in Singapore during the 5-year projection period, the web-based program was the least costly program at all 3 coverage levels. Based on the 100% coverage, the reduced total cost reached nearly SGD 7.1 million and SGD 11.3 million when compared to control and home-based programs at the end of the fifth year, respectively.ConclusionsThe web-based approach was promisingly cost-effective to deliver the postnatal psychoeducational intervention to first-time mothers and could be adopted by hospitals as postnatal care support.Trial RegistrationISRCTN registry ISRCTN45202278; https://www.isrctn.com/ISRCTN45202278

Highlights

The early postpartum period is a stressful transition period for first-time mothers owing to physical and emotional challenges related to childbirth and challenges in adapting to their new social roles, for example, parenting newborns and establishing mother-infant relationship [1,2]
This paper aims to evaluate the cost-effectiveness of web-based and home-based postnatal psychoeducational interventions on outcomes of self-efficacy in newborn care, social support, postnatal depression, and anxiety in first-time mothers during the early postpartum period
There were no significant differences in the baseline outcomes of self-efficacy, social support, postnatal depression, and anxiety among the 3 groups [16]

Summary

Introduction

The early postpartum period is a stressful transition period for first-time mothers owing to physical and emotional challenges related to childbirth and challenges in adapting to their new social roles, for example, parenting newborns and establishing mother-infant relationship [1,2]. Psychoeducational interventions have been developed to improve new mothers’ knowledge in self-care and newborn care during the postnatal period and to build on their strengths and resources to promote emotional coping and parenting skill development [5,7]. Home-based psychoeducation intervention via home visits is not accessible owing to the shortage of midwives and nurses, and its cost-effectiveness was undetermined [5,6,8]. In Singapore, a newly initiated Home Access Program allows lower-income households to afford fiber broadband connectivity and a tablet at a subsidized rate to increase the population’s internet accessibility [12,13], allowing more people to access web-based resources. The accessibility to web-based interventions may significantly reduce people’s reliance on health care professionals, lowering the burden on health care, that is, administrative cost, time, and resource savings [11]. Web-based and home-based psychoeducational interventions have been developed to improve first-time mothers’ postnatal health outcomes, very limited studies have reported their cost-effectiveness

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Results

Conclusion