Global evidence on the cost-effectiveness of interventions for perinatal anxiety and depression

Background

Perinatal anxiety and depression (PAD) are among the most common complications of pregnancy and childbirth. An up-to-date comprehensive synthesis of the available evidence on the cost-effectiveness of interventions targeting these conditions across the perinatal period is lacking. The aim of this systematic review was to identify, synthesize, and critically appraise the available evidence on the cost-effectiveness of interventions for PAD.

Methods

Following PRISMA guidelines, we searched Pubmed, APA PsycINFO, EconLit, and Web of Science from 2000 until 2025. The methodological quality was assessed using the Drummond checklist and the quality of reporting was assessed using the CHEERS checklist. A narrative synthesis summarized economic outcomes across diverse healthcare settings.

Results

We identified 1,093 records. After removing duplicates (n = 412), 681 studies were screened for eligibility. A total of 23 studies met the inclusion criteria, including 14 trials, eight models, and one cohort study. Evidence primarily originated from high-income countries with limited representation (n = 3) from Asia. Sixteen studies were cost-effective, two were not, and five had unclear results. Economic data were stronger for perinatal depression than anxiety. While most studies (n = 24) were of good quality, the reporting of uncertainty and valuations of costs and outcomes remained inconsistent. Furthermore, few studies adequately addressed distributional effects or included patient engagement.

Conclusions

Economic evaluations of interventions for PAD were mostly of good quality, although most evidence originated from high-income countries. Anxiety disorders were underrepresented in the economic evaluation literature. Further studies should focus on assessing the economic value of these interventions in low-income and middle-income settings, with greater attention to perinatal anxiety, which remains understudied.

Key messages

• CBT, interpersonal therapy and primary care interventions for perinatal anxiety and depression are cost-effective and should be prioritised in clinical guidelines.

• Perinatal anxiety remains critically under-evaluated economically, and methodological gaps limit the comparability and policy relevance of existing evidence.