{
  "abstract": "Introduction Perinatal depression in low- and middle-income countries is a global health concern. Interventions to support women suffering from perinatal depression using mental health specialists, such as the WHO Thinking Healthy Programme (WHO-THP), are established but may not be scalable in resource-constrained settings. The technology-assisted peer-delivered THP (THP-TAP) has been developed as a potential solution to deliver an intervention at scale. This study assesses whether the THP-TAP is cost-effective compared with the WHO-THP in Pakistan.Method Using data for 980 pregnant women from a cluster-randomised non-inferiority trial in Pakistan, we conducted a within-trial cost-effectiveness analysis of THP-TAP compared with WHO-THP. Health outcomes are quality-adjusted life-years (QALY) and costs in US$ (2022). Costs collected included intervention delivery costs and wider healthcare resource use costs. The trial intervention delivery costs were adapted to ‘real-world’ intervention delivery costs using evidence and assumptions. Uncertainty was explored through scenario and sensitivity analyses.Results During the trial, the mean patient QALYs were 0.683 (0.681, 0.685) for WHO-THP and 0.688 (0.686, 0.690) for THP-TAP, resulting in an incremental increase in QALYs of 0.005 (0.002, 0.008). The mean per patient costs were $279 ($268, $290) for WHO-THP and $227 for THP-TAP ($218, $236), resulting in an incremental cost of −$52 (−67, −$38). The per patient delivery costs were estimated at $44 and $24 in the real-world scenario, whereas in the trial they were $59 and $69, for WHO-THP and THP-TAP, respectively.THP-TAP is both more effective and less costly than WHO-THP. These results were robust when considering parameter uncertainty and across various scenarios.Conclusions Our analysis suggests that THP-TAP could represent a scalable, health-improving and cost-saving intervention to support those with perinatal depression, when compared with WHO-THP.",
  "authors": [
    {
      "affiliations": [
        "Centre for Health Economics, University of York, York, UK"
      ],
      "name": "Naomi Kate Gibbs"
    },
    {
      "affiliations": [
        "Liverpool School of Tropical Medicine, Liverpool, UK"
      ],
      "name": "Tao Chen"
    },
    {
      "affiliations": [
        "Health Services Academy, Islamabad, Pakistan"
      ],
      "name": "Abid Malik"
    },
    {
      "affiliations": [
        "Human Development Research Foundation, Rawalpindi, Pakistan"
      ],
      "name": "Huma Nazir"
    },
    {
      "affiliations": [
        "University of Liverpool, Liverpool, UK"
      ],
      "name": "Anum Nisar"
    },
    {
      "affiliations": [
        "University of Liverpool, Liverpool, UK"
      ],
      "name": "Ahmed Waqas"
    },
    {
      "affiliations": [
        "Human Development Research Foundation, Rawalpindi, Pakistan"
      ],
      "name": "Najia Atif"
    },
    {
      "affiliations": [
        "Liverpool School of Tropical Medicine, Liverpool, UK"
      ],
      "name": "Duolao Wang"
    },
    {
      "affiliations": [
        "Department of Psychological Sciences, University of Liverpool, Liverpool, UK"
      ],
      "name": "Atif Rahman"
    },
    {
      "affiliations": [
        "University of Liverpool, Liverpool, UK"
      ],
      "name": "Siham Sikander"
    },
    {
      "affiliations": [
        "Centre for Health Economics, University of York, York, UK"
      ],
      "name": "Simon Mark Walker"
    }
  ],
  "title": "Cost-effectiveness of a technology-assisted peer-delivered perinatal mental health intervention in Pakistan: an economic evaluation using trial evidence",
  "uid": "f26f2370-0194-52ba-9b45-65734da7115a"
}