The Cost-Effectiveness of Group Cognitive Behavioral Therapy Compared with Routine Primary Care for Women with Postnatal Depression in the UK

ObjectiveTo assess the cost-effectiveness of group cognitive behavior therapy (gCBT) in comparison with routine primary care for women with postnatal depression in the UK.MethodsOur analysis was based on a systematic literature review of the relative clinical effectiveness of gCBT compared with routine primary care and further reviews, supplemented with expert opinion of the likely cost of providing gCBT and the duration of comparative advantage for gCBT. Raw data were used to estimate a statistical relationship between changes in the Edinburgh Postnatal Depression Score (EPDS) values and changes in short-form six dimensions' (SF-6D) values. A mathematical model was constructed, and probabilistic sensitivity analyses were undertaken to estimate the mean cost per quality-adjusted life-year (QALY) and to evaluate the expected value of perfect information (EVPI).ResultsThe mean cost per QALY from the stochastic analysis was estimated to be £36,062; however, there was considerable uncertainty around this value. The EVPI was estimated to be greater than £64 million; the key uncertainties were in the cost per woman of providing treatment and in the statistical relationship between changes in EPDS values and changes in SF-6D values. The expected value of perfect partial information for both of these parameters was in excess of £25 million.ConclusionsGiven the current information, the use of gCBT does not appear to be cost-effective; however, this decision is uncertain. The value of information analyses conducted indicates that further research to provide robust information on key parameters is needed and appears justified in cost-effective terms.