Cost Effectiveness of Interventions for Perinatal Anxiety and/or Depression: A Systematic Review of Global Evidence.

BACKGROUND AND

objectivePerinatal anxiety and depression are among the most common complications of pregnancy and childbirth. An up-to-date comprehensive synthesis of the available evidence on the cost-effectiveness interventions targeting these conditions across the perinatal period is lacking. The aim of this systematic review was to identify, synthesise and critically appraise the available evidence on the cost-effectiveness of interventions for perinatal anxiety and/or depression.

methodsFollowing the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), a systematic literature review was conducted using PubMed, PsycINFO, EconLit and Web of Science, including only full economic evaluations. The methodological quality of the included studies was assessed using the Drummond checklist, while the quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Evidence was synthesised, using a narrative approach.

resultsTwenty-seven studies were included: 18 trials, eight models, and one cohort study. Eighteen interventions were cost effective, two were not cost effective, and seven reported unclear cost effectiveness. There was substantial economic evidence for interventions targeting perinatal depression compared with interventions targeting perinatal anxiety. Among the interventions for treating and preventing perinatal depression, cognitive behavioral therapy, interpersonal therapy, and primary care delivered through trained health visitors were either cost effective or cost-saving in multiple studies and can therefore be recommended. While most studies (n = 24) were of good quality, the reporting of uncertainty and valuations of costs and outcomes remained inconsistent. Furthermore, few studies adequately addressed distributional effects or included patient engagement. The economic evidence largely originated from high-income countries, with only three studies from Asia and one from Uganda.

conclusionsEconomic evaluations of interventions for perinatal anxiety and/or depression were mostly of good quality, although most evidence originated from high-income countries. Anxiety disorders were underrepresented in the economic evaluation literature. Further studies should focus on assessing the economic value of these interventions in low- and middle-income settings, with greater attention to perinatal anxiety, which remains understudied. CLINICAL

trial registrationOpen Science Framework: https://doi.org/10.17605/OSF.IO/2K4PY .