title: Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of What Were We Thinking.
abstract: Postnatal maternal mental health problems, including depression and anxiety, entail a significant burden globally, and finding cost-effective preventive solutions is a public policy priority. This paper presents a cost-effectiveness analysis of the intervention, What Were We Thinking (WWWT), for the prevention of postnatal maternal mental health problems.
  
  
  
  The economic evaluation, including cost-effectiveness and cost-utility analyses, was conducted alongside a cluster-randomised trial.
  
  
  
  48 Maternal and Child Health Centres in Victoria, Australia.
  
  
  
  Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres. Full data were collected for 175 participants in the control arm and 184 in the intervention arm.
  
  
  
  WWWT is a psychoeducational intervention targeted at the partner relationship, management of infant behaviour and parental fatigue.
  
  
  
  The evaluation considered public sector plus participant out-of-pocket costs, while outcomes were expressed in the 30-day prevalence of depression, anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic, prognostic and clinical characteristics.
  
  
  
  The intervention was estimated to cost $A118.16 per participant. The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes. The incremental cost-effectiveness ratios were $A36 451 per QALY gained and $A152 per percentage-point reduction in 30-day prevalence of depression, anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness threshold of $A55 000 per QALY; however, there was considerable uncertainty surrounding the results, with a 55% probability that WWWT would be considered cost-effective at that threshold.
  
  
  
  The results suggest that, although WWWT shows promise as a preventive intervention for postnatal maternal mental health problems, further research is required to reduce the uncertainty over its cost-effectiveness as there were no statistically significant differences in costs or outcomes.
  
  
  
  ACTRN12613000506796; results.
authors.affiliation: Centre for Health Economics, Monash University, Clayton, Victoria, Australia.
authors.forename: Jemimah
authors.initials: J
authors.lastname: Ride
authors.affiliation: Centre for Health Economics, Monash University, Clayton, Victoria, Australia.|Office of Health Economics, London, UK.
authors.forename: Paula
authors.initials: P
authors.lastname: Lorgelly
authors.affiliation: Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia.
authors.forename: Thach
authors.initials: T
authors.lastname: Tran
authors.affiliation: Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Wynter
authors.affiliation: Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Rowe
authors.affiliation: Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Fisher
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000517:prevention & control*; D001521:Behavior Therapy; D003362:Cost-Benefit Analysis; D019052:Depression, Postpartum / Q000517:prevention & control*; D005260:Female; D005102:Health Expenditures; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D000068097:Maternal Health / Q000191:economics; D008603:Mental Health / Q000191:economics; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods; D011569:Psychiatric Status Rating Scales; D017150:Public Sector; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014739:Victoria
keywords: Cost-effectiveness; Economic evaluation; MENTAL HEALTH; Postnatal depression; Prevention