Cost Effectiveness of Interventions for Perinatal Anxiety and/or Depression: A Systematic Review of Global Evidence.

In 30 seconds

This systematic review synthesised full economic evaluations of interventions for perinatal anxiety and/or depression. It included 27 studies: 18 trials, eight economic models and one cohort study, with evidence assessed narratively. Eighteen interventions were judged cost effective, two were not, and seven had unclear cost effectiveness. Evidence was substantially stronger for perinatal depression than anxiety; cognitive behavioral therapy, interpersonal therapy and primary care delivered by trained health visitors were cost effective or cost-saving in multiple studies. Most evidence came from high-income countries.

Key findings

• Of 27 included studies, 18 interventions were cost effective, two were not cost effective, and seven had unclear cost effectiveness.
• Cognitive behavioral therapy, interpersonal therapy and trained-health-visitor primary care were cost effective or cost-saving in multiple studies.
• Economic evidence was substantially more extensive for perinatal depression than for perinatal anxiety.
• Twenty-four studies were rated as good quality, but reporting of uncertainty and cost and outcome valuations was inconsistent.

Why it matters

Economic evaluations can inform decisions about allocating resources to perinatal mental health care, not just whether interventions improve outcomes. This review identifies several depression interventions with repeated evidence of cost effectiveness or cost savings, while highlighting that the economic case for anxiety interventions is much less established. The geographic concentration of studies also limits how broadly their findings can be applied.

What to keep in mind

Evidence largely came from high-income countries, with only three studies from Asia and one from Uganda. Perinatal anxiety was underrepresented, and reporting of uncertainty and valuations of costs and outcomes was inconsistent.