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Zheng Z, Feng T, Xu J, Zhang X, Yu X. An Evaluation of the Health Economics of Postnatal Depression Prevention and Treatment Strategies in China: A Cost-Effectiveness Analysis. Healthcare (Basel) 2024; 12:1076. [PMID: 38891150 PMCID: PMC11171948 DOI: 10.3390/healthcare12111076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE The primary objectives of this study are to assess the cost-effectiveness of early postnatal screening and prenatal psychological interventions for the prevention and treatment of postpartum depression (PPD) among Chinese pregnant women. Additionally, we aim to explore the most cost-effective prevention and treatment strategies for PPD in China. METHODS We used TreeAge 2019 to construct a decision tree model, with the model assuming a simulated queue size of 10,000 people. The model employed Monte Carlo simulation to assess the cost-effectiveness of PPD prevention and treatment strategies. Transfer probabilities were derived from published studies and meta-analyses. Cost and effectiveness data were obtained from published sources and relevant studies. Incremental cost-effectiveness ratios (ICERs) were used to describe the results, with willingness-to-pay (WTP) thresholds set at China's gross domestic product (GDP) per capita. RESULTS Compared to the usual care group, the cost per additional quality-adjusted life year (QALY) for the early postnatal screening group and the prenatal psychological interventions is USD 6840.28 and USD 3720.74, respectively. The cure rate of mixed treatments for PPD has the greatest impact on the model, while patient participation in treatment has a minor impact on the cost-effectiveness of prevention and treatment strategies. CONCLUSION Both early postnatal screening and prenatal psychological interventions are found to be highly cost-effective strategies for preventing and treating PPD in China. Prenatal psychological interventions for pregnant women are the most cost-effective prevention and treatment strategy. As such, from the perspective of national payers, we recommend that maternal screening for PPD be implemented in China to identify high-risk groups early on and to facilitate effective intervention.
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Affiliation(s)
| | | | | | | | - Xihe Yu
- School of Public Health, Jilin University, Changchun 130022, China; (Z.Z.); (T.F.); (J.X.); (X.Z.)
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A practical guide to the use of psychotropic medications during pregnancy and lactation. Arch Psychiatr Nurs 2019; 33:254-266. [PMID: 31227078 DOI: 10.1016/j.apnu.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022]
Abstract
The use of psychotropic medications during the perinatal period is often met with fear and discomfort on the part of both clinicians and patients. There is a great deal of misinformation about the risks of medication use during pregnancy and lactation. The risk of untreated or undertreated mental illness during this time is an important consideration when making treatment recommendations. This paper serves as a practical guide for clinicians who may be treating patients with psychotropic medication during the perinatal period. A heuristic tool for making treatment decisions will be introduced, and coverage of specific psychiatric disorders and medication classes will be provided.
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Nice FJ, DeEugenio D, DiMino TA, Freeny IC, Rovnack MB, Gromelski JS. Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part III. J Pharm Technol 2016. [DOI: 10.1177/875512250402000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective:To provide a guide for practicing pharmacists, pharmacy technicians, and other healthcare professionals so that they are able to counsel and advise breast-feeding mothers and fellow healthcare professionals on the safety and use of antiinfectives, vaccines, antiepileptics, benzodiazepines, psychotherapeutic drugs, and radiopharmaceuticals during breast-feeding.Data Sources:Primary texts used by the breast-feeding community ( Medications and Mothers' Milk, Drugs in Pregnancy and Lactation, Drugs and Human Lactation) were searched, as well as Micromedex, MEDLINE, PubMed, EMBASE, and EMBASE2 (1984–February 2004).Study Selection/Data Extraction:Multiple sources were used wherever available to validate the data, and primary articles were used to verify all tertiary source information. Search terms included breast-feeding, lactation, nursing, and medications, as well as specific drug names.Data Synthesis:Concerns regarding medication use during breast-feeding have caused mothers to either discontinue nursing or not take necessary medications. Complete avoidance of medications or cessation of breast-feeding is often unnecessary. Although there are drugs that can be harmful to nursing infants, breast-milk concentrations of most drugs are insufficient to cause any harm.Conclusions:Having objective and reliable information on medications enables pharmacists, pharmacy technicians, other healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
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Affiliation(s)
- Frank J Nice
- FRANK J NICE MS MPA DPA CPHP, Assistant Director, Clinical Neurosciences Program (CNP), National Institutes of Health (NIH), Bethesda, MD
| | - Deborah DeEugenio
- DEBORAH DeEUGENIO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Assistant Professor, School of Pharmacy, Temple University, Philadelphia, PA; Clinical Pharmacist, Jefferson Antithrombotics Therapy Service, Jefferson Heart Institute, Philadelphia
| | - Traci A DiMino
- TRACI A DiMINO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Adverse Event Specialist, Global Safety Surveillance & Epidemiology, Wyeth, Collegeville, PA
| | - Ingrid C Freeny
- INGRID C FREENY PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Medical Student, Drexel University College of Medicine, Philadelphia
| | - Marissa B Rovnack
- MARISSA B ROVNACK PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Clinical Staff Pharmacist, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Joseph S Gromelski
- JOSEPH S GROMELSKI PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Pharmacist, Walmart, Baltimore, MD; Law Student, University of Maryland, Baltimore
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Abstract
Depression commonly affects women, particularly during their childbearing years. Often, pharmacologic therapy is the recommended treatment. Today, medication selection generally involves the newer antidepressants, with tricyclic antidepressant and monoamine oxidase inhibitors reserved for more refractory patients. Although there is ample evidence to support the benefits of breastfeeding in the infant, the scientific literature contains little information with regard to the transfer of antidepressants from the plasma into breast milk and the subsequent effects on the developing infant. Secondary to this lack of safety data, many clinicians and mothers are reluctant to breastfeed during antidepressant treatment. This article will review the literature for reports of the newer antidepressants' use during lactation.
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Affiliation(s)
- E A Winans
- Psychiatric Clinical Research Center, University of Illinois, University of Illinois College of Pharmacy, Department of Psychiatry, 1601 W. Taylor, 4th Floor, Chicago, IL 60612, USA
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