Cost-utility of public health nurse-delivered group cognitive behavioural therapy for postpartum depression

BACKGROUND: Postpartum depression (PPD) is associated with an increased risk of adverse outcomes for birthing parents, their children, and healthcare systems. Public health nurse (PHN)-delivered group cognitive behavioural therapy (CBT) can effectively treat PPD and has potential to be scaled, but its cost-effectiveness remains unknown. The purpose of this study was to examine the cost-utility of a PHN-delivered group CBT intervention for treating PPD added to treatment as usual (TAU) compared to TAU alone. METHODS: This economic evaluation was conducted alongside an RCT in Ontario, Canada. Birthing parents ≥18 years old with an infant ≤12 months and an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 were randomly assigned to receive PHN-delivered group CBT plus TAU or TAU alone. Costs were calculated based on healthcare service use over the 35-week trial period. The EQ-5D-3L was collected at baseline, 9 weeks, and 6 months later and used to calculate quality adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was calculated. Non-parametric bootstrapping was used to estimate uncertainty and generate a cost-effectiveness acceptability curve (CEAC). RESULTS: The intervention was associated with a 0.023 (95 % CI -0.058, 0.011) QALY gain and mean additional cost of $238 (95 % CI -$1749, $2227) compared to the control group. The ICER was $10,347 per QALY gained. At a willingness-to-pay of $50,000 for one QALY, PHN-delivered group CBT had a 75 % probability of being cost effective. CONCLUSIONS: This trial-based cost-utility analysis found that PHN-delivered group CBT for treating PPD added to TAU may be cost-effective compared to TAU alone.