Maximizing maternal health and value for money in postpartum depression screening: a cost-effectiveness analysis using the All Our Families cohort and administrative data in Alberta, Canada

Introduction: Postpartum depression (PPD) affects 10-15% of women, yet often remains under recognized and undiagnosed. Within Alberta, Canada, screening is conducted at public health well child clinics, where nurses use the Edinburgh Postnatal Depression Scale to screen women and, if high-risk, offer referral to their family physicians for follow up diagnosis and treatment.

Methods: We developed a decision tree to estimate the cost-effectiveness of PPD screening versus not screening over a two-year time horizon, using a public payer perspective. Both the current practice (51% attending referral) and a scenario analysis (100% attending referral) are presented. Probabilistic model parameters were derived using All Our Families cohort data linked to Alberta-based administrative data.

Results: Current practice results suggested PPD screening leads to an incremental cost-effectiveness ratio (ICER) of $23,428 per quality adjusted life year (QALY). At a population-level, screening resulted in 813 additional cases diagnosed, 120 additional QALYs gained, and a cost of $2.8 million annually relative to not screening. With 100% referral attendance, the ICER fell to $18,468 per QALY, resulting in 1997 additional cases diagnosed, 249 additional QALYs gained, and a cost of $4.6 million annually across the population, relative to not screening.

Conclusion: Although screening is currently offered to all women in Alberta, indicating wide availability of the intervention, screening is most valuable when participation and compliance for the program are maximized. Collaboration among public health and primary care services involved along the PPD screening and care pathway is encouraged to address barriers and improve outcomes.