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Randomized Controlled Trial
. 2024 Aug;30(8):2343-2348.
doi: 10.1038/s41591-024-03069-5. Epub 2024 Jun 6.

A cost-effectiveness analysis of early detection and bundled treatment of postpartum hemorrhage alongside the E-MOTIVE trial

Eleanor V Williams  1 , Ilias Goranitis  2 , Raymond Oppong  1 , Samuel J Perry  1 , Adam J Devall  1 , James T Martin  1 , Kristie-Marie Mammoliti  1 , Leanne E Beeson  1 , Kulandaipalayam N Sindhu  1 , Hadiza Galadanci  3 , Fadhlun Alwy Al-Beity  4 , Zahida Qureshi  5 , G Justus Hofmeyr  6   7 , Neil Moran  8 , Sue Fawcus  9 , Sibongile Mandondo  10   11 , Lee Middleton  1 , Karla Hemming  1 , Olufemi T Oladapo  12 , Ioannis D Gallos  12 , Arri Coomarasamy  1 , Tracy E Roberts  13
Affiliations
Randomized Controlled Trial

A cost-effectiveness analysis of early detection and bundled treatment of postpartum hemorrhage alongside the E-MOTIVE trial

Eleanor V Williams et al. Nat Med. 2024 Aug.

Abstract

Timely detection and treatment of postpartum hemorrhage (PPH) are crucial to prevent complications or death. A calibrated blood-collection drape can help provide objective, accurate and early diagnosis of PPH, and a treatment bundle can address delays or inconsistencies in the use of effective interventions. Here we conducted an economic evaluation alongside the E-MOTIVE trial, an international, parallel cluster-randomized trial with a baseline control phase involving 210,132 women undergoing vaginal delivery across 78 secondary-level hospitals in Kenya, Nigeria, South Africa and Tanzania. We aimed to assess the cost-effectiveness of the E-MOTIVE intervention, which included a calibrated blood-collection drape for early detection of PPH and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination and escalation), compared with usual care. We used multilevel modeling to estimate incremental cost-effectiveness ratios from the perspective of the public healthcare system for outcomes of cost per severe PPH (blood loss ≥1,000 ml) avoided and cost per disability-adjusted life-year averted. Our findings suggest that the use of a calibrated blood-collection drape for early detection of PPH and bundled first-response treatment is cost-effective and should be perceived by decision-makers as a worthwhile use of healthcare budgets. ClinicalTrials.gov identifier: NCT04341662 .

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Conflict of interest statement

G.J.H. has consulted for Equalize Health, a not-for-profit health technology company. This did not influence the design, conduct or reporting of the research presented in this manuscript. The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Summary of the E-MOTIVE intervention.
The E-MOTIVE intervention included a calibrated blood-collection drape for early detection of PPH and a bundle of first-response treatments (uterine massage, oxytocic drugs, TXA, IV fluids, examination and escalation), supported by an implementation strategy.
Fig. 2
Fig. 2. Randomization of hospitals in the E-MOTIVE trial.
All participating hospitals entered a 7-month baseline period in which they provided usual care for patients having vaginal delivery. After the baseline phase, hospitals were randomly assigned in a 1:1 ratio to receive the E-MOTIVE intervention or to continue providing usual care. Eighty hospitals across Kenya, Nigeria, South Africa and Tanzania underwent randomization. Due to participating in a conflicting program, two hospitals in Tanzania did not receive the assigned intervention. Data for analysis were therefore available from 78 hospitals, with a total of 210,132 patients. Source-verified blood loss data for analysis were available for 206,455 patients.
Fig. 3
Fig. 3. Cost-effectiveness acceptability curve indicating the probability of the E-MOTIVE intervention being cost-effective across different WTP thresholds for a DALY averted.
The dashed lines show the expected WTP for a DALY averted, as estimated from WHO recommendations (green) and Woods and colleagues (blue).
Extended Data Fig. 1
Extended Data Fig. 1. Costing assumptions.
Costing assumptions used for economic evaluation.
See this image and copyright information in PMC

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