Group CBT is not cost-effective for treating postnatal depression

shutterstock_35039089 postnatal depression

The objective of this cost-utility analysis was to assess the cost-effectiveness of providing group cognitive-behavioural therapy (CBT), compared with routine primary care, for women with postnatal depression in the UK.

Group CBT was compared with routine primary care for women with postnatal depression, defined by their Edinburgh Postnatal Depression Scale (EPDS) score, with scores ranging from 12 to 30 (maximum) suggesting significant depression.

The data were synthesised using a mathematical model constructed by the authors. The data were identified by a systematic literature review, with expert opinion for some items. The time horizon was one year and the authors reported that the UK NHS and personal social services perspective was adopted.

A systematic review was performed for the clinical effectiveness of group CBT and the details were published in a UK Health Technology Assessment report. Only one randomised controlled trial (RCT) was identified, which involved 45 patients who were provided CBT in weekly two-hour psycho-educational group sessions, with four to six women per class, for eight weeks, and followed-up patients for six months. An expert panel, including psychologists, primary medical care staff, and consultants, provided estimates on the duration of effectiveness over one year, for group CBT, and assumed that the improvement in EPDS score with CBT at six months, compared with routine care, declined linearly to zero by one year. The main outcome measure was the reduction in EPDS score.

The measure of benefit was quality-adjusted life-years (QALYs).

The results showed that:

  • Compared with routine care, the additional cost per woman for providing group CBT was £1,500 and this generated an additional 0.032 QALYs; the incremental cost per QALY gained was £46,462.
  • When the cost per woman receiving group CBT was reduced to £750, it was cost-effective at a threshold of £30,000 per QALY gained. Plausible scenarios produced cost per QALY values below £20,000.
  • The probabilistic analysis indicated that group CBT resulted in an additional 0.039 QALYs, and an additional cost of £1,418, and the cost per QALY gained was £36,062.
  • The EVPI indicated that to remove all uncertainty decision-makers would have to pay a maximum of £64 million. The key parameters with the greatest EVPPI values were the cost per women of providing group CBT and the statistical relationship between the EPDS values and SF-6D values that were used to derive the QALYs.

The authors concluded that group CBT did not appear to be cost-effective, but research was needed to reduce the uncertainty in the costs and effectiveness.

Stevenson MD, Scope A, Sutcliffe PA. The cost-effectiveness of group cognitive behavioral therapy compared with routine primary care for women with postnatal depression in the UK. Value Health. 2010 Aug;13(5):580-4. Epub 2010 Mar 31. [PubMed abstract]

Stevenson MD, Scope A, Sutcliffe PA, Booth A, Slade P, et al. Group cognitive-behavioural therapy for postnatal depression: a systematic review of clinical and cost effectiveness and value of information analyses. Health Technology Assessment 2010; 14(44): 1-135.

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