by Annette Bauer, Martin Knapp, Dave McDaid
Postnatal depression costs the economy around £45 million each year in England and Wales (Petrou et al. 2002), at a conservative estimate based on additional health and social care services. On a moderate to severe level, the condition affects approximately 13% of women in the early months following childbirth (O’Hara and Swain 1996). At present, primary care offers only a low chance of women being identified with depression (Murray et al. 2004; Kessler et al. 2002). By contrast, an alternative approach involves a universal screening and intervention programme for postnatal depression, using trained health visitors who screen all women after they give birth. This was found to be beneficial both in terms of improved outcomes for women and their children, and as a cost-effective alternative to routine care (Morrell 2009).
Researchers from PSSRU set out to examine the economic benefits of a universal screening programme, and found that in the long term there were net benefits to the economy of £640 per mother. By extrapolation, this amounts to around £300 million for England. This was derived from a decision model comparing routine care with a universal intervention programme.
There are costs involved: implementing the programme would require around £1,400 in funding per health visitor (derived from Morell et al. 2009 and Cowley and Bidmead 2009), which includes the cost of training and additional time spent with mothers for screening and counselling. The current costs of identification and treatment in routine care were estimated at £35 per mother, while the additional costs associated with intervention were just under £160. The model takes into account the loss of productivity for women who are unable to return to work due to untreated depression; the amount of women falling into this category is likely to be higher in the routine care than in the intervention programme, because fewer cases would be identified. While there are unlikely to be cost savings to the Government associated with the programme in this first year, in the medium term, it is likely that cost savings can be achieved because treatment costs and productivity loss could be further reduced.
Our study has revealed that even in the short-term, substantial improvements in mothers’ quality of life and an increase in productivity for those who return to work in the first year make the universal screening programme economically viable. Gaps in the research evidence remain, which present challenges in exploring the true scope of this viability, for example, we were only able to look at the short-term impact on mothers health and productivity. Future development of the model is needed to estimate the economic consequences for children and possibly fathers over a longer time-horizon. We are currently engaged in research to explore these developments.
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