{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T01:38:30Z","timestamp":1790386710306,"version":"4.1.0"},"reference-count":59,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,10,21]]},"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Postnatal maternal mental health problems, including depression and anxiety, entail a significant burden globally, and finding cost-effective preventive solutions is a public policy priority. This paper presents a cost-effectiveness analysis of the intervention, <jats:italic>What Were We Thinking (WWWT)<\/jats:italic>, for the prevention of postnatal maternal mental health problems.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>The economic evaluation, including cost-effectiveness and cost-utility analyses, was conducted alongside a cluster-randomised trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>48 Maternal and Child Health Centres in Victoria, Australia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres. Full data were collected for 175 participants in the control arm and 184 in the intervention arm.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>\n                     <jats:italic>WWWT<\/jats:italic> is a psychoeducational intervention targeted at the partner relationship, management of infant behaviour and parental fatigue.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measures<\/jats:title>\n                  <jats:p>The evaluation considered public sector plus participant out-of-pocket costs, while outcomes were expressed in the 30-day prevalence of depression, anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic, prognostic and clinical characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The intervention was estimated to cost $A118.16 per participant. The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes. The incremental cost-effectiveness ratios were $A36\u2005451 per QALY gained and $A152 per percentage-point reduction in 30-day prevalence of depression, anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness threshold of $A55\u2005000 per QALY; however, there was considerable uncertainty surrounding the results, with a 55% probability that <jats:italic>WWWT<\/jats:italic> would be considered cost-effective at that threshold.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The results suggest that, although <jats:italic>WWWT<\/jats:italic> shows promise as a preventive intervention for postnatal maternal mental health problems, further research is required to reduce the uncertainty over its cost-effectiveness as there were no statistically significant differences in costs or outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=347752\" ext-link-type=\"uri\">ACTRN12613000506796<\/jats:ext-link>; results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-012086","type":"journal-article","created":{"date-parts":[[2016,11,18]],"date-time":"2016-11-18T22:01:00Z","timestamp":1479506460000},"page":"e012086","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of <i>What Were We Thinking<\/i>"],"prefix":"10.1136","volume":"6","author":[{"given":"Jemimah","family":"Ride","sequence":"first","affiliation":[{"name":"Centre for Health Economics, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Lorgelly","sequence":"additional","affiliation":[{"name":"Centre for Health Economics, Monash University, Clayton, Victoria, Australia"},{"name":"Office of Health Economics, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thach","family":"Tran","sequence":"additional","affiliation":[{"name":"Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Wynter","sequence":"additional","affiliation":[{"name":"Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Rowe","sequence":"additional","affiliation":[{"name":"Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Fisher","sequence":"additional","affiliation":[{"name":"Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,11,18]]},"reference":[{"key":"2025101814563605000_6.11.e012086.1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000183597.31630.db"},{"key":"2025101814563605000_6.11.e012086.2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.091850"},{"key":"2025101814563605000_6.11.e012086.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00737-005-0108-6"},{"key":"2025101814563605000_6.11.e012086.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2010.07.035"},{"key":"2025101814563605000_6.11.e012086.5","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/JOM.0b013e31823fdf85","article-title":"Postpartum depression and health services expenditures among employed women","volume":"54","author":"Dagher","year":"2012","journal-title":"J Occup Environ Med"},{"key":"2025101814563605000_6.11.e012086.6","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1762.2001.00432.x"},{"key":"2025101814563605000_6.11.e012086.7","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.181.6.505"},{"key":"2025101814563605000_6.11.e012086.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta7370","article-title":"Redesigning postnatal care: a randomised controlled trial of protocol-based midwifery-led care focused on individual women's physical and psychological health needs","volume":"7","author":"MacArthur","year":"2003","journal-title":"Health Technol Assess"},{"key":"2025101814563605000_6.11.e012086.9","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1017\/S0266462306051361","article-title":"Cost-effectiveness of a preventive counseling and support package for postnatal depression","volume":"22","author":"Petrou","year":"2006","journal-title":"Int J Technol Assess"},{"key":"2025101814563605000_6.11.e012086.10","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1055\/s-0032-1331029","article-title":"Prospective economic evaluation of a peer support intervention for prevention of postpartum depression among high-risk women in Ontario, Canada","volume":"30","author":"Dukhovny","year":"2013","journal-title":"Am J Perinatol"},{"key":"2025101814563605000_6.11.e012086.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7261.593"},{"key":"2025101814563605000_6.11.e012086.12","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1111\/cp.12054","article-title":"A review of partner-inclusive interventions for preventing postnatal depression and anxiety","volume":"19","author":"Pilkington","year":"2015","journal-title":"Clin Psychol\u2014UK"},{"key":"2025101814563605000_6.11.e012086.13","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-10-432"},{"key":"2025101814563605000_6.11.e012086.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006436"},{"key":"2025101814563605000_6.11.e012086.15","unstructured":"Department of Education and Early Childhood Development Victoria. Maternal and Child Health Service Program Standards, 2009."},{"key":"2025101814563605000_6.11.e012086.16","unstructured":"Department of Education & Training. Maternal and Child Health Annual Report Archive: State Government Victoria. 2014. http:\/\/www.education.vic.gov.au\/childhood\/providers\/support\/Pages\/mchannualreportarchive.aspx"},{"key":"2025101814563605000_6.11.e012086.17","unstructured":"Edgecombe G , White S , Marsh G , et al . First-time parent group resource and facilitation guide for maternal and child health nurses. Melbourne: Victorian Department of Human Services, 2001:1\u2013120."},{"key":"2025101814563605000_6.11.e012086.18","unstructured":"Department of Education and Early Childhood Development Victoria, Municipal Association of Victoria. Memorandum of Understanding between Department of Education and Early Childhood Development AND Municipal Association of Victoria in relation to Maternal and Child Health Services July 2012\u2014June 2015. VIC, Australia, 2012."},{"key":"2025101814563605000_6.11.e012086.19","doi-asserted-by":"crossref","unstructured":"Drummond MF , Sculpher MJ , Torrance GW , et al . Methods for the economic evaluation of health care programmes. 3rd edn. Oxford, UK: Oxford University Press, 2005.","DOI":"10.1093\/oso\/9780198529446.001.0001"},{"key":"2025101814563605000_6.11.e012086.20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540150055031"},{"key":"2025101814563605000_6.11.e012086.21","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.54.3.340"},{"key":"2025101814563605000_6.11.e012086.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2007.06.013"},{"key":"2025101814563605000_6.11.e012086.23","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.3390\/ijerph7041835","article-title":"Health economic assessment: cost-effectiveness thresholds and other decision criteria","volume":"7","author":"Simoens","year":"2010","journal-title":"Int J Environ Res Public Health"},{"key":"2025101814563605000_6.11.e012086.24","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1002\/hec.3085","article-title":"The willingness to pay for a quality adjusted life year: a review of the empirical literature","volume":"24","author":"Ryen","year":"2015","journal-title":"Health Econ"},{"key":"2025101814563605000_6.11.e012086.25","doi-asserted-by":"publisher","DOI":"10.1002\/hec.1481"},{"key":"2025101814563605000_6.11.e012086.26","unstructured":"NICE. Guide to the methods of technology appraisal 2013. UK: NICE, 2013."},{"key":"2025101814563605000_6.11.e012086.27","doi-asserted-by":"publisher","DOI":"10.3310\/hta19880"},{"key":"2025101814563605000_6.11.e012086.28","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006226"},{"key":"2025101814563605000_6.11.e012086.29","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009396"},{"key":"2025101814563605000_6.11.e012086.30","doi-asserted-by":"publisher","DOI":"10.1370\/afm.141"},{"key":"2025101814563605000_6.11.e012086.31","unstructured":"Australian Government Department of Health. MBS Online: Commonwealth of Australia. http:\/\/www.mbsonline.gov.au\/internet\/mbsonline\/publishing.nsf\/Content\/downloads"},{"key":"2025101814563605000_6.11.e012086.32","unstructured":"Independent Hospital Pricing Authority. National Efficient Price Determination 2013-14: Commonwealth of Australia. http:\/\/www.ihpa.gov.au\/internet\/ihpa\/publishing.nsf\/content\/nep-determination-2013-14"},{"key":"2025101814563605000_6.11.e012086.33","unstructured":"American Psychiatric Association. Diagnostic and statistical manual-text revision (DSM-IV-TRim, 2000). American Psychiatric Association, 2000."},{"key":"2025101814563605000_6.11.e012086.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2011.04.009"},{"key":"2025101814563605000_6.11.e012086.35","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8510(96)00822-6"},{"key":"2025101814563605000_6.11.e012086.36","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-014-0136-z"},{"key":"2025101814563605000_6.11.e012086.37","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-010-1487-6"},{"key":"2025101814563605000_6.11.e012086.38","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/j.1542-2011.2011.00106.x","article-title":"The importance of mode of birth after previous cesarean: success, satisfaction, and postnatal health","volume":"57","author":"Shorten","year":"2012","journal-title":"J Midwifery Womens Health"},{"key":"2025101814563605000_6.11.e012086.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2007.06.003"},{"key":"2025101814563605000_6.11.e012086.40","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/s00737-013-0384-5","article-title":"PRIME: impact of previous mental health problems on health-related quality of life in women with childbirth trauma","volume":"16","author":"Turkstra","year":"2013","journal-title":"Arch Womens Ment Health"},{"key":"2025101814563605000_6.11.e012086.41","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-7-40"},{"key":"2025101814563605000_6.11.e012086.42","unstructured":"Australian Bureau of Statistics. Socio-Economic Index for Areas. 2013. http:\/\/www.abs.gov.au\/websitedbs\/censushome.nsf\/home\/seifa"},{"key":"2025101814563605000_6.11.e012086.43","doi-asserted-by":"crossref","unstructured":"Glick HA , Doshi JA , Sonnad SS , et al . Economic evaluation in clinical trials. 2nd edn. Oxford, UK: Oxford University Press, 2015.","DOI":"10.1093\/med\/9780199685028.001.0001"},{"key":"2025101814563605000_6.11.e012086.44","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-200406000-00007"},{"key":"2025101814563605000_6.11.e012086.45","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9001000308"},{"key":"2025101814563605000_6.11.e012086.46","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.187.2.106"},{"key":"2025101814563605000_6.11.e012086.47","unstructured":"Kirkwood B , Sterne J . Essential medical statistics: John Wiley & Sons, Ltd, 2003."},{"key":"2025101814563605000_6.11.e012086.48","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-6296(98)00039-3"},{"key":"2025101814563605000_6.11.e012086.49","doi-asserted-by":"publisher","DOI":"10.3310\/hta13070"},{"key":"2025101814563605000_6.11.e012086.50","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1754.2002.00723.x"},{"key":"2025101814563605000_6.11.e012086.51","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3944"},{"key":"2025101814563605000_6.11.e012086.52","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.110.082453"},{"key":"2025101814563605000_6.11.e012086.53","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.113.136036"},{"key":"2025101814563605000_6.11.e012086.54","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099-1050(199905)8:3<203::AID-HEC413>3.0.CO;2-7"},{"key":"2025101814563605000_6.11.e012086.55","doi-asserted-by":"crossref","first-page":"2538","DOI":"10.1002\/sim.6112","article-title":"Sample size calculation in cost-effectiveness cluster randomized trials: optimal and maximin approaches","volume":"33","author":"Manju","year":"2014","journal-title":"Stat Med"},{"key":"2025101814563605000_6.11.e012086.56","doi-asserted-by":"publisher","DOI":"10.1080\/j.1440-1614.2006.01871.x"},{"key":"2025101814563605000_6.11.e012086.57","unstructured":"Australian Bureau of Statistics. Pregnancy and work transitions. 2013 (20 November 2015). http:\/\/www.abs.gov.au\/ausstats\/abs@.nsf\/Lookup\/4102.0Main+Features10Nov+2013"},{"key":"2025101814563605000_6.11.e012086.58","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.18.1737"},{"key":"2025101814563605000_6.11.e012086.59","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2016-012086","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T21:56:46Z","timestamp":1760824606000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2016-012086"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11]]},"references-count":59,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2016,11,18]]},"published-print":{"date-parts":[[2016,11]]}},"alternative-id":["10.1136\/bmjopen-2016-012086"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2016-012086","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11]]}}}