Modelled cost-effectiveness of interpersonal therapy and exercise classes for the prevention of postnatal depression

Postnatal depression (PND) affects 16% of new mothers in Australia and is associated with social withdrawal, insomnia, self-harm and in some instances infant-harm. This study sought to investigate whether interpersonal psychotherapy (IPT) and exercise classes for the prevention of PND are potentially cost-effective in the current Australian context A Markov model estimated the cost per quality-adjusted life year (QALY) gained and return on investment (ROI) ratio for women in Australia who gave birth in 2016 for the intervention when compared to no intervention. Evidence of effectiveness was sourced from meta-analyses. Women moved between three health states: ‘non-depressed’, ‘depressed’ (meeting the criteria for PND) and ‘dead’, over one-year and five-year timeframes. Intervention costs included Medicare Benefits Schedule costs. Healthcare costs were sourced from Australian studies andproductivity costs associated with absenteeism used data form the Australian Bureau of Statistics. IPT was estimated to be dominant (95% Uncertainty Interval (UI): Dominant−$15,592) with incremental QALYs of 572 (95%UI: 292920) and total costs of -$8.75M (95%UI: -$19.70M,1.97M) when delivered by psychologists in a combination of group and individual settings. Sensitivity analysis for IPT also showed that delivery by maternal and child health nurses would also be cost-saving. Exercise classes were estimated to be dominant (95% UI: Dominant− Dominated). However, uncertainty remains around the effectiveness of exercise classes in preventing PND. IPT is and cost-effective preventative therapy for preventing women at risk of PND. Exercise classes have the potential to be cost-effective but require further trials to ascertain their effectiveness.