When the cradle falls II: the cost-effectiveness of treating postnatal depression in a psychiatric day hospital compared with routine primary care

Background: This prospective cohort study assessed the cost-effectiveness of treating 30 women with postnatal depression (PND) at a specialised psychiatric Parent and Baby Day Unit (PBDU), compared to 30 women treated using routine primary care (RPC). Methods: Following recruitment, the women were assessed on three occasions (initially, 3- and 6-months), using a variety of social and psychiatric outcome measures. Direct and indirect costs were collated using structured interviews, retrospective analysis of case notes and routinely collated NHS cost data. Sensitivity analysis was also carried out. Results: There was no significant difference between the women in the two groups initially in terms of their socio-demographic characteristics, or scores on the outcome measures. However, at 6-months, 21 women in the PBDU group were no longer depressed compared to only seven women in the RPC group. The total cost was £46 211 for the PBDU group and £18 973 for the RPC group. Moving from RPC to a PBDU would involve an additional expenditure of £27 238 (46 211–18 973) whilst delivering 14 more positive outcomes. The move from RPC to PBDU would incur an additional cost per successfully treated woman of £1945 (27 238/14). This compares favourably with the current cost per successfully treated woman in the RPC group of £2710 (18 973/7). Conclusions: RPC is dominated on the grounds of cost-effectiveness by PBDU treatment and so PBDU treatment should be recommended to health care decision-makers. Limitations of the study: The results were sensitive to the inclusion of primary care contacts and the costs of medication.