Protocol for an economic evaluation of scalable strategies to improve mental health among perinatal women: non-specialist care delivered via telemedicine vs. specialist care delivered in-person.

Autor: Singla DR; Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada. daisy.singla@utoronto.ca.; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. daisy.singla@utoronto.ca.; Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada. daisy.singla@utoronto.ca., de Oliveira C; Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.; ICES, Toronto, Canada., Murphy SM; Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA., Patel V; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.; Department of Global Health and Population, Harvard Chan School of Public Health, Boston, USA., Charlebois J; Canadian Perinatal Mental Health Collaborative, Barrie, Canada., Davis WN; Postpartum Support International, Portland, USA., Dennis CL; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.; Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada.; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada., Kim JJ; Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Evanston, USA., Kurdyak P; Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.; ICES, Toronto, Canada., Lawson A; Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada., Meltzer-Brody S; Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, USA., Mulsant BH; Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada., Schoueri-Mychasiw N; Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada., Silver RK; Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Evanston, USA.; Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, USA., Tschritter D; Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada., Vigod SN; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.; Women's College Hospital, Toronto, Canada., Byford S; King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Jazyk: angličtina
Zdroj: BMC psychiatry [BMC Psychiatry] 2023 Nov 08; Vol. 23 (1), pp. 817. Date of Electronic Publication: 2023 Nov 08.
DOI: 10.1186/s12888-023-05318-2
Abstrakt: Background: Perinatal depression affects an estimated 1 in 5 women in North America during the perinatal period, with annualized lifetime costs estimated at $20.6 billion CAD in Canada and over $45.9 billion USD in the US. Access to psychological treatments remains limited for most perinatal women suffering from depression and anxiety. Some barriers to effective care can be addressed through task-sharing to non-specialist providers and through telemedicine platforms. The cost-effectiveness of these strategies compared to traditional specialist and in-person models remains unknown. This protocol describes an economic evaluation of non-specialist providers and telemedicine, in comparison to specialist providers and in-person sessions within the ongoing Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial.
Methods: The economic evaluation will be undertaken alongside the SUMMIT trial. SUMMIT is a pragmatic, randomized, non-inferiority trial across five North American study sites (N = 1,226) of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a behavioural activation treatment for perinatal depressive and anxiety symptoms. The primary economic evaluation will be a cost-utility analysis. The outcome will be the incremental cost-effectiveness ratio, which will be expressed as the additional cost required to achieve an additional quality-adjusted life-year, as assessed by the EuroQol 5-Dimension 5-Level instrument. A secondary cost-effectiveness analysis will use participants' depressive symptom scores. A micro-costing analysis will be conducted to estimate the resources/costs required to implement and sustain the interventions; healthcare resource utilization will be captured via self-report. Data will be pooled and analysed using uniform price and utility weights to determine cost-utility across all trial sites. Secondary country-specific cost-utility and cost-effectiveness analyses will also be completed. Sensitivity analyses will be conducted, and cost-effectiveness acceptability-curves will be generated, in all instances.
Discussion: Results of this study are expected to inform key decisions related to dissemination and scale up of evidence-based psychological interventions in Canada, the US, and possibly worldwide. There is potential impact on real-world practice by informing decision makers of the long-term savings to the larger healthcare setting in services to support perinatal women with common mental health conditions.
(© 2023. The Author(s).)
Databáze: MEDLINE
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