Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit

Abstract

AimTo evaluate the cost effectiveness of carbetocin compared to oxytocin when used as prophylaxis against post‐partum hemorrhage (PPH) during cesarean deliveries.MethodsA systematic review of the literature was performed to identify randomized controlled trials that compared the use of carbetocin to oxytocin in the context of cesarean deliveries. Cost effectiveness analysis was then performed using secondary data from the perspective of a maternity unit within the Malaysian Ministry of Health, over a 24 h time period.ResultsSeven randomized controlled trials with over 2000 patients comparing carbetocin with oxytocin during cesarean section were identified. The use of carbetocin in our center, which has an average of 3000 cesarean deliveries annually, would have prevented 108 episodes of PPH, 104 episodes of transfusion and reduced the need for additional uterotonics in 455 patients. The incremental cost effectiveness ratio of carbetocin for averting an episode of PPH was US$278.70.ConclusionReduction in retreatment, staffing requirements, transfusion and potential medication errors mitigates the higher index cost of carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section, carbetocin was cost effective as prophylaxis against PPH. Ultimately, the relative value placed on the outcomes above and the individual unit's resources would influence the choice of uterotonic.

A systematic review of the cost‐effectiveness of uterotonic agents for the prevention of postpartum hemorrhage

“…Included studies were conducted in Columbia, Ecuador, India, Malaysia, Mexico . Peru, Senegal, Tanzania, Uganda, and the UK .…”

“…Eleven of these studies were conducted from 2011 to 2018 and four studies were conducted from 2007 to 2010 . Out of the 15 studies, three studies were funded by pharmaceutical companies, six studies were funded by organizations and institutions, such as WHO, the Bill and Melinda Gates Foundation, Department for International Development, National Institute for Health Research, and others, three studies were not funded, in two studies (abstracts) it was unclear whether they were funded or not, and one study did not disclose funding sources …”

“…Six studies evaluated the cost‐effectiveness of misoprostol versus third stage management without any uterotonics (five studies) or oxytocin (one study), all of which were conducted in settings with low access to facility births . A further eight studies evaluated the cost‐effectiveness of carbetocin versus oxytocin across various facility settings …”

“…Eight cost‐effectiveness analyses and one service evaluation study contributed data . Four were from a high‐income country (UK) and five were from middle‐income countries (Columbia, Ecuador, Malaysia, Mexico, and Peru).…”

“…Apart from the UK‐based study that evaluated several uterotonic options, all studies compared carbetocin (100 μg) to oxytocin (5 or 10 IU, if dose was reported). Four studies based their cost‐effectiveness analysis on effectiveness outcome data of a published Cochrane systematic review of carbetocin for preventing PPH, three evaluations were based on prospective studies, one on the findings of the NMA, and the source of the effectiveness data in one study reported as a conference abstract was unclear…”