The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study

Georgina M Chambers; Willings Botha; Nicole Reilly; Emma Black; Dawn Kingston; Marie-Paule Austin

doi:10.1016/j.wombi.2021.05.007

The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study

Women Birth. 2022 Mar;35(2):e133-e141. doi: 10.1016/j.wombi.2021.05.007. Epub 2021 Jun 5.

Authors

Georgina M Chambers¹, Willings Botha¹, Nicole Reilly², Emma Black³, Dawn Kingston⁴, Marie-Paule Austin⁵

Affiliations

¹ National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW, 2052 Australia.
² Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia; Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia.
³ Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia.
⁴ Faculty of Nursing, University of Calgary, 2500 University Drive, NW, University of Calgary, Calgary, AB T2N 1N4, Canada.
⁵ Perinatal and Women's Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; Royal Hospital for Women, Sydney, Barker Street, Randwick, NSW 2031, Australia. Electronic address: m.austin@unsw.edu.au.

PMID: 34099393
DOI: 10.1016/j.wombi.2021.05.007

Abstract

Problem: Although perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain.

Aim: To compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA).

Methods: Women attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an 'at-risk' flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the 'at-risk' flag for PIPA than for Usual-Care. Each model's performance was evaluated using the midwife's agreement with the 'at-risk' flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach.

Findings: Both models performed well at identifying 'at-risk' women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying 'at-risk' women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted.

Discussion: Overall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as 'at-risk' and 'not at-risk' of perinatal psychosocial morbidity.

Keywords: Cost-effectiveness; Depression screening; Pregnancy; Psychosocial assessment.

MeSH terms

Cohort Studies
Cost-Benefit Analysis
Female
Humans
Mass Screening
Maternal Health Services*
Pregnancy
Pregnancy Complications* / diagnosis
Pregnancy Complications* / psychology