Abstract：
Half of women with depression in the perinatal period are not identified in routine care, and missed cases reflect inequalities in other areas of maternity care. Case finding (screening) for depression in pregnant women may be a cost-effective strategy to improve identification, and targeted case finding directs finite resources towards the greatest need. We compared the cost-effectiveness of three case-finding strategies: no case finding, universal (all pregnant women), and targeted (only pregnant women with risk factors for antenatal depression, i.e. history of anxiety/depression, age < 20 years, and adverse life events). A decision tree model was developed to represent case finding (at around 20 weeks gestation) and subsequent treatment for antenatal depression (up to 40 weeks gestation). Costs include case finding and treatment. Health benefits are measured as quality-adjusted life years (QALYs). The sensitivity and specificity of case-finding instruments and prevalence and severity of antenatal depression were estimated from a cohort study of pregnant women. Other model parameters were derived from published literature and expert consultation. The most cost-effective case-finding strategy was a two-stage strategy comprising the Whooley questions followed by the PHQ-9. The mean costs were £52 (universal), £61 (no case finding), and £62 (targeted case finding). Both case-finding strategies improve health compared with no case finding. Universal case finding is cost-saving. Costs associated with targeted case finding are similar to no case finding, with greater health gains, although targeted case finding is not cost-effective compared with universal case finding. Universal case finding for antenatal depression is cost-saving compared to no case finding and more cost-effective than targeted case finding.
摘要：
一半围产期患有抑郁症的女性在常规护理中没有被发现，漏发的病例反映了产妇护理其他领域的不平等。孕妇抑郁症的病例发现（筛查）可能是一种具有成本效益的策略，以提高识别，有针对性的案例查找将有限的资源用于最大的需求。我们比较了三种病例发现策略的成本效益：无病例发现，普遍（所有孕妇），并有针对性（仅具有产前抑郁症危险因素的孕妇，即焦虑/抑郁史，年龄<20岁，和不良生活事件)。开发了决策树模型来表示病例发现（在妊娠约20周）和随后的产前抑郁症治疗（妊娠长达40周）。费用包括病例发现和治疗。健康益处以质量调整生命年(QALY)来衡量。通过对孕妇的队列研究，估计了病例发现工具的敏感性和特异性以及产前抑郁症的患病率和严重程度。其他模型参数来自已发表的文献和专家咨询。最具成本效益的病例发现策略是两阶段策略，包括Whooley问题，然后是PHQ-9。平均费用为52英镑(普遍)，£61（无案件发现），和£62（有针对性的病例发现）。与没有病例发现相比，两种病例发现策略都可以改善健康状况。通用案例查找可以节省成本。与有针对性的病例发现相关的成本类似于没有病例发现，随着更大的健康收益，尽管与普遍病例发现相比，有针对性的病例发现不具成本效益。与没有病例发现相比，产前抑郁症的普遍病例发现可以节省成本，并且比目标病例发现更具成本效益。
