Cost-effectiveness of Carbetocin versus Oxytocin for Prevention of Postpartum Hemorrhage Resulting from Uterine Atony in Women at high-risk for bleeding in Colombia

Abstract

Objective To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/ cesarean section in women with risk factors for bleeding. Methods A decision tree was developed for vaginal delivery and another one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only direct medical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year time horizon. The costs were expressed in 2016 Colombian pesos (1 USD ¼ 3,051 Col$). Results In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin, while the QALYs were 0.9980 and 0.9979, respectively. The incremental costeffectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. Conclusion In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.

Side‐effects of carbetocin to prevent postpartum hemorrhage: A systematic review and meta‐analysis of randomized controlled trials

“…The absolute cost of carbetocin is several times higher than oxytocin 31 . Some researchers have even found there is no economic benefit with the use of carbetocin for women from the point of view of health system 32,33 …”

Economic Evaluation of Carbetocin as Prophylaxis for Postpartum Hemorrhage in the Philippines

“…Results of analysis in Colombia also found carbetocin not cost-effective in VD population 14 . On another hand, our study had contrasting results compared to other published studies when CS population is considered.…”

“…On another hand, our study had contrasting results compared to other published studies when CS population is considered. Carbetocin was consistently cost-effective for use in CS population on studies in a high-income country such as UK 29 and upper-middle income countries such as Malaysia 16 , Peru 17 , Colombia 14 and Ecuador 15 . The difference between our results could be attributed with the difference in input values for costs -cost of treatment for PPH-related complications is low from the data we retrieved.…”

“…The decision tree was based from previous economic evaluations 14,15,17,18,20,21 , review of clinical practice guidelines and consultation from clinical experts in the Philippines. In the model, women can either go through VD or CS ( Figure 1).…”

“…A systematic review of economic evaluations (EE) 13 suggested cost-effectiveness for CS (e.g. Colombia 14 , Ecuador 15 , Malaysia 16 , Peru 17 and UK 18 ), while it was not cost-effective for VD in Colombia 14 . However, the systematic review also rated the quality of evidence low, due to uncertainties around costs, other input variables and incomplete description of methods 13 .…”