Cost-effectiveness of virtual Mindfulness-Based Cognitive Therapy on pregnancies at high risk of perinatal depression.

Abstract

Previous research has shown that preventive counseling for women at high risk of perinatal depression leads to a reduction in the development of perinatal depression and is cost-effective. Barriers of cost, transit, time, and staffing limit accessibility of these services. We examined whether a theoretical, virtual, group, social worker (SW)-led Mindfulness-Based Cognitive Therapy (MBCT) program for patients at high risk of perinatal depression would be cost-effective. We developed a decision-analytic model using TreeAge to compare outcomes in pregnant patients at high risk of perinatal depression who received a preventive virtual group MBCT curriculum versus standard care. We used a theoretical cohort of 469,000 patients, representing the number of annual pregnancies to individuals with a history of depression in the United States. Outcomes included postpartum depression, maternal suicide, postpartum psychosis, preterm birth, neonatal death, and neurodevelopmental delay in addition to cost and quality-adjusted life years (QALYs). The willingness-to-pay threshold was set to $100,000/QALY. Literature searches were used to identify model inputs, and sensitivity analyses were conducted to assess model robustness. Within the theoretical cohort of 469,000 people, the virtual, group, SW-led MBCT curriculum prevented 26,180 cases of postpartum depression, 1 maternal suicide, 2 cases of postpartum psychosis, 4044 preterm deliveries, 39 neonatal deaths, and 47 cases of neurodevelopmental delay. The MBCT strategy led to lower costs (saving $152,496,858) and better outcomes (15,052 gained QALYs), making it cost-saving. Sensitivity analyses demonstrated that MBCT remained cost-saving until treatment reached $800, and cost-effective until $4014, both of which were significantly higher than the expected cost of MBCT delivery. We found that virtual SW-led group MBCT led to better outcomes and lower costs for pregnant patients at high risk of depression. Given these findings, the benefits to high-risk patients, and the shortage of mental health providers, such preventive mental health models should be examined for broader implementation.