The results of a study by academics in the University's Department of Health Sciences, Hull York Medical School and the Centre for Health Economics suggest that both the NICE recommendation and widespread current practice should be reviewed.
More than one in 10 women suffer from postnatal depression six weeks after giving birth, yet fewer than half of cases are detected in routine clinical practice. Screening strategies using brief depression questionnaires have been advocated but have attracted substantial controversy. Furthermore, guidelines issued by NICE in 2007 recommend the use of specific questions to identify possible postnatal depression, but the effectiveness and value for money of this strategy is uncertain.
The researchers at York used a computer model to evaluate the cost effectiveness of screening for postnatal depression in primary care. Professor Simon Gilbody who led the project, said: "While postnatal depression is a very important condition, screening for this disorder with questionnaires was costly and wrongly identified many women as depressed, resulting in inappropriate care."
Screening for postnatal depression with one of the most widely used questionnaires, the Edinburgh Postnatal Depression Scale, had an incremental cost effectiveness ratio of £41,103 per quality adjusted life year or QALY (a combined measure of quantity and quality of life) compared with routine care only.
The ratio for all other strategies ranged from £49,928 to £272,463 per QALY compared with routine care only, well above the conventional NHS cost effectiveness threshold of £20-30,000 per QALY. In contrast, the strategy of treating post natal depression without using screening as is current practice represented good value for money.
MEDICA.de; Source: University of York