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Q&A

Healthcare Policy/Economics

Poster Session 2

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

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Lindsay Quinn, BA, BS

Medical Student (MS-3)
Oregon Health & Science University
Portland, OR, United States

Coauthor(s)

RB

Riane Bradbury-Huang, N/A

Undergraduate Student
Barnard College
New York, NY, United States
Ellen L. Tilden, PhD,MS,RN,NP

Associate Professor
Oregon Health & Science University, School of Nursing
Portland, OR, United States
Olivia J. Curl, BA, MPH

MD/MPH Candidate 2024
Oregon Health & Science University
Portland, OR, United States
UD

Uma Doshi, BS, MCR (she/her/hers)

Medical Student
Oregon Health & Science University
Portland, OR, United States
TS

Taylor Shank, PhD

Postdoctoral Researcher
Oregon Health & Science University
Portland, OR, United States
Aaron B. Caughey, MD, PhD

Professor and Chair
Oregon Health & Science University
Portland, OR, United States

Objective: Previous research has shown preventive counseling for women at high risk of perinatal depression to be cost-effective. Barriers of cost, transit, time, and staffing limit accessibility of these services. We examined whether a theoretical virtual, group, social worker (SW)-administered Mindfulness Based Cognitive Therapy (MBCT) program for patients at high risk of perinatal depression would be cost-effective.

Study Design: We used TreeAge to create a cost-effectiveness model of outcomes in pregnant patients at high risk of perinatal depression who received antenatal virtual group MBCT curriculum versus standard of care. We used a theoretical cohort of 480,390 patients, representing pregnancies at high risk of postpartum depression annually. Outcomes included perinatal depression, maternal suicide, postpartum psychosis, infanticide, preterm birth, neonatal death, and cerebral palsy in addition to cost and quality-adjusted life years (QALYs). The willingness-to-pay threshold was set to $100,000/QALY. Literature searches found model inputs, and sensitivity analysis assessed model strength.

Results: Within the theoretical cohort, the virtual, group, SW-led MBCT curriculum prevented 26,821 cases of perinatal depression, 2 cases of maternal suicide, 3 cases of postpartum psychosis, 4,142 cases of preterm delivery, 40 cases of neonatal death, and 48 cases of neurodevelopmental delay. There was no significant reduction in infanticide. The MBCT strategy was cost-saving. Sensitivity analyses demonstrated that MBCT remained cost-effective until treatment costs reached $4,015, significantly higher than expected cost. The incremental cost-effectiveness ratio (ICER) was -$10,141/QALY, indicating cost savings per QALY gained. SW-administered MBCT is superior to standard of care, yielding higher QALYs at lower cost.

Conclusion: We found it cost-saving to offer virtual, group SW-administered MBCT to pregnant patients at high risk of depression. Clinicians should pursue implementing similar programs.