Economic evaluation of Learning Through Play Plus in comparison to usual care for depressed mothers alongside a randomised controlled trial

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BACKGROUND: Research on the cost-effectiveness of postnatal depression treatments is limited in developing countries and among ethnic minorities in developed nations. This study presents a health economic evaluation of an integrated parenting intervention, Learning Through Play Plus (LTP+), for postnatal depression and child development, compared to treatment as usual (TAU), alongside a randomised controlled trial in Pakistan. METHODS: Using data on 764 mothers from the ROSHNI-PK trial, we conducted an economic evaluation over a six-month time horizon to assess the cost-effectiveness of LTP+ from the perspective of health, social care and patient in Pakistan. Cost-utility was analysed using EQ-5D-3L instrument while cost-effectiveness was assessed using the Edinburgh Postnatal Depression Scale (EPDS) for mother and the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE) for the child. Cost-utility analysis was conducted for mother-only and partially for mother-child dyad, as EQ-5D-3L data were collected for mother only, whereas cost-effectiveness was conducted for both dyad and mother-only. Incremental cost-effectiveness ratios (ICERs) were calculated from adjusted mean costs and outcomes. RESULTS: Delivering LTP+ cost US $68.7 per dyad. LTP+ increased maternal costs by $33 (95% CI: $24: $43) and gained 0.06 (CI: 0.05: 0.07) quality-adjusted life-years (QALYs) compared to TAU-only. For the dyad, costs increased by $15 (CI: $4: $25). The ICER per maternal QALY gained was $582 (CI: $404: $769) when only maternal costs were considered, and $258 (CI: $75: $442) when dyad costs were considered. Dyad recovery (normal EPDS and ASQ: SE scores) cost $29 (CI: $11: $49), while maternal recovery alone cost $80 (CI: $53: $111). Dyad analyses showed that LTP+ has a 100% likelihood of being more cost-effective than TAU-only at willingness-to-pay thresholds of $65 per recovery or $600 per QALY gain. Analyses with varying combinations of LTP+ and healthcare costs and outcomes confirmed that the cost per QALY gained from LTP+ consistently remained below Pakistan's annual per capita gross domestic product (GDP). CONCLUSION: LTP+ combined with TAU resulted in higher QALYs and recovery rates but at higher costs than TAU alone. While not cost-saving, LTP+ has a very high likelihood of being more cost-effective than TAU alone if the willingness-to-pay per QALY is at least 25% of Pakistan's 2015 annual GDP per capita. TRIAL: # NCT02047357; Pre participant trial enrolment, 21/01/2014.

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