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. 2022 Nov;6(6):847-857.
doi: 10.1007/s41669-022-00362-2. Epub 2022 Sep 6.

What is the Economic Cost of Providing an All Wales Postpartum Haemorrhage Quality Improvement Initiative (OBS Cymru)? A Cost-Consequences Comparison with Standard Care

Megan Dale  1 , Sarah F Bell  2 , Susan O'Connell  3 , Cerys Scarr  4 , Kathryn James  2 , Miriam John  5 , Rachel E Collis  2 , Peter W Collins  6 , Grace Carolan-Rees  7
Affiliations

What is the Economic Cost of Providing an All Wales Postpartum Haemorrhage Quality Improvement Initiative (OBS Cymru)? A Cost-Consequences Comparison with Standard Care

Megan Dale et al. Pharmacoecon Open. 2022 Nov.

Abstract

Background and objective: A postpartum haemorrhage quality improvement initiative (the Obstetric Bleeding Strategy for Wales [OBS Cymru]), including about 60,000 maternities, was adopted across Wales (2017-2018). We performed a cost-consequences analysis to inform ongoing provision and wider uptake.

Methods: Analysis was based on primary data from the All Wales postpartum haemorrhage database, with a UK National Health Services perspective, a time horizon from delivery until hospital discharge and no discounting. Costs were based on UK published sources with viscoelastic haemostatic assay costs provided by the OBS Cymru national team. Mean costs per eligible patient (postpartum haemorrhage > 1000 mL) were calculated for OBS Cymru, using the early implementation period as a comparator. Modelling allowed comparisons of three scenarios (two predefined and one post hoc) and implementation in different sizes of maternity unit.

Results: All analyses demonstrated consistent savings in blood products, critical care and haematology time, and also a reduced occurrence of massive postpartum haemorrhage (> 2500 mL). Incremental postnatal length of stay varied between scenarios, substantially impacting on total costs. Mean incremental cost of OBS Cymru, compared with standard care, across Wales was £18.41 per patient (postpartum haemorrhage > 1000 mL) or - £10.66 if the length of stay was excluded. Modelling a maternity unit of 5000 births per annum, OBS Cymru incurred an incremental cost of £9.53 per patient with postpartum haemorrhage > 1000 mL.

Conclusions: OBS Cymru reduces the occurrence of massive postpartum haemorrhage, need for transfusions, quantity of blood products and intensive care. In medium-to-large maternity units (>3000 maternities per annum), the OBS Cymru intervention approaches cost neutrality compared to standard care.

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Conflict of interest statement

RE Collis has received research support from CSL Behring, Werfen and Haemonetics. PW Collins has received honoraria from CSL Behring and Werfen and research support from CSL Behring, Werfen and Haemonetics. He has received support to attend a conference from CSL Behring. All other authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Incremental cost of Obstetric Bleeding Strategy for Wales [OBS Cymru] (per woman with postpartum haemorrhage [PPH]) for obstetric units between 500 and 6000 maternities per annum
Fig. 2
Fig. 2
Incremental cost attributed to each cost component for the three scenarios. OBS Cymru Obstetric Bleeding Strategy for Wales, PPH postpartum haemorrhage
Fig. 3
Fig. 3
Illustration of the impact of the length of stay on the results. PPH postpartum haemorrhage
Fig. 4
Fig. 4
Incremental results for each scenario when the length of stay is excluded. OBS Cymru Obstetric Bleeding Strategy for Wales, PPH postpartum haemorrhage
See this image and copyright information in PMC

References

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    1. Welsh Government. Implementation of OBS Cymru (Obstetric Bleeding Strategy for Wales), a management strategy for postpartum haemorrhage (PPH), in maternity services. Welsh Health Circular. WHC/2019/012 (2019). Available from: https://gov.wales/sites/default/files/publications/2019-04/implementatio.... [Accessed 16 Mar 2021].
    1. Bell SF, Kitchen T, John M, Scarr C, Kelly K, Bailey C, et al. Designing and implementing an all Wales postpartum haemorrhage quality improvement project: OBS Cymru (the Obstetric Bleeding Strategy for Wales) BMJ Open Qual. 2020;9(2):e000854. doi: 10.1136/bmjoq-2019-000854. - DOI - PMC - PubMed
    1. Bell SF, Collis RE, Pallmann P, Bailey C, James K, John M, et al. Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study. BMC Pregnancy Childbirth. 2021;21(1):377. doi: 10.1186/s12884-021-03853-y. - DOI - PMC - PubMed
    1. Bell SF, Collis RE, Bailey C, James K, John M, Kelly K, et al. The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study. Int J Obstet Anesth. 2021;47:102983. doi: 10.1016/j.ijoa.2021.102983. - DOI - PubMed

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