{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T23:31:49Z","timestamp":1789428709224,"version":"build-2803163510"},"reference-count":42,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T00:00:00Z","timestamp":1721088000000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH115830"],"award-info":[{"award-number":["R01MH115830"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2024,7,2]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We conducted a cost-effectiveness analysis of an evidence-based collaborative care model for treatment of perinatal depression among women living with HIV in Uganda.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Maternal Depression Treatment in HIV (M-DEPTH) is a cluster randomised controlled trial implemented from July 2019 to August 2023, during which 391 pregnant women with mild-to-severe depressive symptoms were randomised to receive stepped care for depression (M-DEPTH: behavioural and pharmacological treatments) or care as usual (CAU: hospital referral for severe cases), at one of eight public health facilities in Uganda.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We implemented time-driven, activity-based costing to determine the economic cost of M-DEPTH from a societal perspective, compared with CAU. Change in the prevalence of depressive disorder\u2014from enrolment to 18 months postpartum\u2014was quantified using the Patient Health Questionnaire, with depressive disorder assigned a disability weight according to the Global Burden of Disease project. Incremental cost-effectiveness ratios (ICERs) were expressed as cost per disability-adjusted life years (DALY) averted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The estimated economic cost of M-DEPTH was US$128.82 per participant, compared with $1.53 per participant for CAU. At baseline, prevalence of depressive disorder did not differ according to treatment assignment. Remission of depressive disorder was more prevalent among those assigned to M-DEPTH\u2014across all time periods, including 18-month follow-up (aOR: 0.09; 95%\u2009CI 0.05 to 0.16; p&lt;0.001). This yielded an ICER of $397 per DALY averted, when limiting benefits to those accrued over the study period. Sensitivity analyses generated estimates ranging from $162 to $418 per DALY averted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>M-DEPTH represents a financially feasible task-shifted model of evidence-based perinatal depression screening and treatment. The intervention is cost-effective at a willingness-to-pay threshold of less than half of median gross domestic product per capita in Uganda.<\/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\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03892915\">NCT03892915<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2023-000754","type":"journal-article","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T02:55:12Z","timestamp":1721184912000},"page":"e000754","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Economic evaluation of Maternal Depression Treatment in HIV (M-DEPTH) for perinatal depression among women living with HIV in Uganda: a cost-effectiveness analysis"],"prefix":"10.1136","volume":"2","clinical-trial-number":[{"clinical-trial-number":"nct03892915","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0073-0348","authenticated-orcid":false,"given":"Ryan","family":"McBain","sequence":"first","affiliation":[{"name":"Health Care Delivery, RAND Corporation, Santa Monica, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeyemi","family":"Okunogbe","sequence":"additional","affiliation":[{"name":"Healthcare Delivery, RAND Corporation, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violet","family":"Gwokyalya","sequence":"additional","affiliation":[{"name":"Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhoda K","family":"Wanyenze","sequence":"additional","affiliation":[{"name":"School of Public Health, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn","family":"Wagner","sequence":"additional","affiliation":[{"name":"Health Care Delivery, RAND Corporation, Santa Monica, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,7,16]]},"reference":[{"key":"2025083110263805000_2.1.e000754.1","doi-asserted-by":"publisher","DOI":"10.1086\/648446"},{"key":"2025083110263805000_2.1.e000754.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.9.1167"},{"key":"2025083110263805000_2.1.e000754.3","unstructured":"UNAIDS . 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