Perinatal depression in mothers is common and is associated with preterm birth and low birth weight. Although screening is widely recommended, many pregnant patients who screen positive or have elevated risk do not receive preventive mental health care. Barriers such as cost, transportation, time, staffing, insurance coverage, and limited availability of trained mental health providers make scalable preventive models especially important.

Bradbury-Huang et al. [Pregnancy] conducted a cost-effectiveness analysis to examine whether a virtual, group, social worker-led Mindfulness-Based Cognitive Therapy (MBCT) program would be economically favorable for pregnant patients at high risk of perinatal depression. The authors developed a decision-analytic model using TreeAge software to compare preventive virtual group MBCT with standard care. Standard care was defined as usual perinatal care without routine preventive counseling, including situations in which depression screening may occur but does not lead to adequate treatment.

The model used a theoretical cohort of 469,000 pregnancies, representing the estimated annual number of pregnancies in the United States among individuals with a history of depression. The modeled outcomes included postpartum depression, maternal suicide, postpartum psychosis, infanticide, preterm birth, neonatal death, neurodevelopmental delay, total costs, and quality-adjusted life years. Model probabilities, costs, utilities, and outcome estimates were drawn from published literature. The willingness-to-pay threshold was set at $100,000 per quality-adjusted life year.

In the model, preventive virtual group MBCT led to better outcomes and lower costs than standard care. Among 469,000 high-risk pregnancies, the MBCT strategy prevented an estimated 26,180 cases of postpartum depression, 1 maternal suicide, 2 cases of postpartum psychosis, 4,044 preterm deliveries, 39 neonatal deaths, and 47 cases of neurodevelopmental delay. Infanticide was unchanged. MBCT was also cost-saving, reducing estimated costs by $152,496,858 while gaining 15,052 quality-adjusted life years. When only hospital costs were included, rather than broader societal costs, MBCT remained cost-saving.

Sensitivity analyses supported the robustness of the model. The assumed cost of MBCT delivery was $480 per person. The intervention remained cost-saving until the treatment cost exceeded $800 and remained cost-effective until the cost exceeded $4,014. MBCT also remained cost-saving as long as the post-intervention preterm birth rate stayed below 10.26%, compared with a baseline untreated estimate of 10.49%. A Monte Carlo simulation of 10,000 trials found that virtual group MBCT was cost-effective in 96.7% of simulations.

This study suggests that a virtual, social worker-led MBCT may be a scalable and economically favorable strategy for preventing perinatal depression among high-risk pregnant patients. The findings are especially relevant given the shortage of perinatal mental health providers and the need for lower-cost preventive interventions that can be delivered remotely. The study supports further implementation research and prospective trials testing real-world uptake, adherence, clinical effectiveness, and health-system integration of virtual MBCT in perinatal care. However, the findings should be interpreted as model-based rather than trial-based evidence.

Reference:

Bradbury-Huang, R., Quinn, L., Tilden, E. L., & Caughey, A. B. (2026). Cost-effectiveness of virtual Mindfulness-Based Cognitive Therapy on pregnancies at high risk of perinatal depression. Pregnancy, 2(3), e70305. 

Link to study