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. 2019 Jun;3(2):163-176.
doi: 10.1007/s41669-018-0108-x.

Uterotonic Drugs for the Prevention of Postpartum Haemorrhage: A Cost-Effectiveness Analysis

Karen Pickering  1 , Ioannis D Gallos  2 , Helen Williams  2 , Malcolm J Price  3 , Abi Merriel  2 , David Lissauer  2 , Aurelio Tobias  2 , G Justus Hofmeyr  4 , Arri Coomarasamy  2 , Tracy E Roberts  5
Affiliations

Uterotonic Drugs for the Prevention of Postpartum Haemorrhage: A Cost-Effectiveness Analysis

Karen Pickering et al. Pharmacoecon Open. 2019 Jun.

Abstract

Objective: The objective of this study was to estimate the relative cost effectiveness for the full range of uterotonic drugs available for preventing postpartum haemorrhage (PPH).

Methods: A model-based economic evaluation was constructed using effectiveness data from a network meta-analysis, and supplemented by the literature. A UK National Health Service (NHS) perspective was adopted for the analysis, which is based on UK costs from published sources. The primary outcome measure is cost per case of PPH avoided (≥ 500 mL blood loss), with secondary outcome measures of cost per case of severe PPH avoided (≥ 1000 mL) and cost per major outcome (surgery) averted also being analysed.

Results: Carbetocin is shown to be the most effective strategy. Excluding adverse events, 'ergometrine plus oxytocin' was shown to be the least costly strategy. The incremental cost-effectiveness ratio for prevention of PPH with carbetocin compared with prevention with 'ergometrine plus oxytocin' was £1889 per case of PPH ≥ 500 mL avoided; £30,013 per case of PPH ≥ 1000 mL avoided; and £1,172,378 per major outcome averted. Including adverse events in the analysis showed oxytocin to be the least costly strategy. The incremental cost-effectiveness ratio for prevention of PPH with carbetocin compared with prevention with oxytocin was £928 per case of PPH ≥ 500 mL avoided; £22,900 per case of PPH ≥ 1000 mL avoided; and £894,514 per major outcome averted.

Conclusion: The results suggest carbetocin, oxytocin and 'ergometrine plus oxytocin' could all be favourable options for being the most cost-effective strategy for preventing PPH. Carbetocin could be the preferred choice, especially if the price of carbetocin decreased. Mixed findings mean a clear-cut conclusion cannot be made as to which uterotonic is the most cost effective. Future research should focus on collecting more robust evidence on the probability of having adverse events from the uterotonic drugs, and on adapting the model for low- and middle-income countries.

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Conflict of interest statement

All authors Karen Pickering, Ioannis D. Gallos, Helen Williams, Malcolm J. Price, Abi Merriel, David Lissauer, Aurelio Tobias, Prof. G. Justus Hofmeyr, Prof. Arri Coomarasamy, and Prof. Tracy E. Roberts declare no competing interests.

Figures

Fig. 1
Fig. 1
Summarised version of the clinical pathways in the model
Fig. 2
Fig. 2
Cost-effectiveness acceptability curve between prevention strategies oxytocin and carbetocin, using distributions around the accuracy data
See this image and copyright information in PMC

References

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