Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 17, 2020
Date Accepted: Nov 18, 2021
The cost-effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers: an economic evaluation alongside randomized controlled trial
ABSTRACT
Background:
The cost-effectiveness of interventions has attracted increasing interest among researchers. While web-based and home-based psychoeducational interventions have been developed to improve first-time mothers’ postnatal health outcomes, very limited studies have reported their cost-effectiveness.
Objective:
To evaluate the cost-effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period.
Methods:
A randomized controlled three-group pre-test and post-test design was adopted, and a cost-effectiveness analysis from the healthcare’s perspective was conducted. A total of 204 primiparas were recruited from a public tertiary hospital in Singapore from October 2016 to August 2017, and they were randomly allocated to the web-based (n = 68), home-based (n = 68), or control (n = 68) groups. Outcomes of maternal parental self-efficacy, social support, postnatal depression, anxiety and healthcare resource utilization were measured using valid and reliable instruments at baseline, as well as at 1 month, 3 months and 6 months after childbirth. The generalized linear regression models on effectiveness and cost were used to assess the incremental cost-effectiveness ratios of the web-based and home-based intervention programs compared to routine care. Projections of cumulative cost over five years incurred by each strategy at various intervention program coverage levels (i.e. 10%, 50% and 100%) were also estimated.
Results:
The web-based intervention program dominated the other two programs (home-based program and routine care) with the least cost and the best improvements in self-efficacy, social support and psychological well-being. During the five-year projection period, the web-based program was the most cost-saving program at all three coverage levels, and the differences of total cost reached nearly 7 and 11 million Singapore dollars when compared to control and home-based programs at the end of the fifth year, respectively. In comparison to the web-based and control programs over a period of five years, the home-based program was the least cost-saving program in terms of total cost incurred.
Conclusions:
The web-based approach was the most cost-effective approach to deliver the postnatal psychoeducational intervention to first-time mothers and can be adopted by hospitals for postnatal care support. Clinical Trial: ISRCTN45202278
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