Cost-effectiveness and budget impact of heat-stable carbetocin compared to oxytocin and misoprostol for the prevention of postpartum hemorrhage (PPH) in women giving birth in India

Cook, John R.; Saxena, Kunal; Taylor, Catharine; Jacobs, Jeffrey L.

doi:10.1186/s12913-023-09263-4

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…In terms of health economic evidence, a network meta-analysis and systematic review found the relative cost-effectiveness of heat-stable carbetocin compared to alternative strategies to be inconclusive due to the uncertainty and inconsistency in the data reported on adverse events [37,38]. Yet some recent studies in LMICs have shown that heat-stable carbetocin can be a cost-effective alternative to oxytocin [39][40][41]. The manufacturer of heat-stable carbetocin has made a commitment to increase its availability to primary health care facilities in LMICs at an affordable price [35].…”

Section: Plos Global Public Healthmentioning

confidence: 99%

Modeling the economic burden of postpartum hemorrhage due to substandard uterotonics in Ghana

Bautista,

Lee,

Higgins

et al. 2024

PLOS Glob Public Health

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Uterotonics are essential in preventing postpartum hemorrhage (PPH), the leading direct cause of maternal death worldwide. However, uterotonics are often substandard in low- and middle-income countries, contributing to poor maternal health outcomes. This study examines the health and economic impact of substandard uterotonics in Ghana. A decision-tree model was built to simulate vaginal and cesarean section births across health facilities, uterotonic quality and utilization, PPH risk and diagnosis, and resulting health and economic outcomes. We utilized delivery data from Ghana’s maternal health survey, risks of health outcomes from a Cochrane review, and E-MOTIVE trial data for health outcomes related to oxytocin quality. We compared scenarios with and without substandard uterotonics, as well as scenarios altering uterotonic use and care-seeking behaviors. We found that substandard uterotonic use contributes to $18.8 million in economic burden annually, including $6.3 million and $4.8 million in out-of-pocket expenditures in public and private sectors, respectively. Annually, the National Health Insurance Scheme bears $1.6 million in costs due to substandard uterotonic use. Substandard uterotonics contribute to $6 million in long-term productivity losses from maternal mortality annually. Improving the quality of uterotonics could reduce 20,000 (11%) PPH cases, 5,000 (11%) severe PPH cases, and 100 (11%) deaths due to PPH annually in Ghana. Ensuring the quality of uterotonics would result in millions of dollars in cost savings and improve maternal health outcomes for the government and families in Ghana. Cost savings from improving uterotonic quality would provide financial protection and help Ghana advance toward Universal Health Coverage.

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Section: Plos Global Public Healthmentioning

confidence: 99%

Modeling the economic burden of postpartum hemorrhage due to substandard uterotonics in Ghana

Bautista,

Lee,

Higgins

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

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The cost-effectiveness of preventing, diagnosing, and treating postpartum haemorrhage: A systematic review of economic evaluations

Ginnane,

Aziz,

Sultana

et al. 2024

PLoS Med

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Background Postpartum haemorrhage (PPH) is an obstetric emergency. While PPH-related deaths are relatively rare in high-resource settings, PPH continues to be the leading cause of maternal mortality in limited-resource settings. We undertook a systematic review to identify, assess, and synthesise cost-effectiveness evidence on postpartum interventions to prevent, diagnose, or treat PPH. Methods and findings This systematic review was prospectively registered on PROSPERO (CRD42023438424). We searched Medline, Embase, NHS Economic Evaluation Database (NHS EED), EconLit, CINAHL, Emcare, Web of Science, and Global Index Medicus between 22 June 2023 and 11 July 2024 with no date or language limitations. Full economic evaluations of any postpartum intervention for prevention, detection, or management of PPH were eligible. Study screening, data extraction, and quality assessments (using the CHEC-E tool) were undertaken independently by at least 2 reviewers. We developed narrative syntheses of available evidence for each intervention. From 3,993 citations, 56 studies were included: 33 studies of preventative interventions, 1 study assessed a diagnostic method, 17 studies of treatment interventions, 1 study comparing prevention and treatment, and 4 studies assessed care bundles. Twenty-four studies were conducted in high-income countries, 22 in upper or lower middle-income countries, 3 in low-income countries, and 7 studies involved countries of multiple income levels. Study settings, methods, and findings varied considerably. Interventions with the most consistent findings were the use of tranexamic acid for PPH treatment and using care bundles. In both cases, multiple studies predicted these interventions would either result in better health outcomes and cost savings, or better health outcomes at acceptable costs. Limitations for this review include that no ideal setting was chosen, and therefore, a transferability assessment was not undertaken. In addition, some sources of study uncertainty, such as effectiveness parameters, were interrogated to a greater degree than other sources of uncertainty. Conclusions In this systematic review, we extracted, critically appraised, and summarised the cost-effectiveness evidence from 56 studies across 16 different interventions for the prevention, diagnosis, and treatment of PPH. Both the use of tranexamic acid as part of PPH treatment, and the use of comprehensive PPH bundles for prevention, diagnosis, and treatment have supportive cost-effectiveness evidence across a range of settings. More studies utilizing best practice principles are required to make stronger conclusions on which interventions provide the best value. Several high-priority interventions recommended by World Health Organization (WHO) such as administering additional uterotonics, non-pneumatic anti-shock garment, or uterine balloon tamponade (UBT) for PPH management require robust economic evaluations across high-, middle-, and low-resource settings.

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A Cost-Effectiveness and Budget Impact Analysis of the Introduction of Heat Stable Carbetocin for Postpartum Hemorrhage Prevention in Nigeria

Amode,

Oyedele,

Salele

et al. 2023

Preprint

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Background Nigeria contributes about 28.5% of the global maternal death burden and 22% of these deaths are attributable to postpartum hemorrhage (PPH). The World Health Organization recommends that the administration of a potent uterotonic agent within the first minute of birth is critical to preventing PPH. Studies reveal preponderance of low-quality oxytocin, misoprostol and other uterotonics in Nigeria due to substandard manufacturing practices, weak regulatory oversight, broken cold-chain systems, demanding climactic conditions (high heat; high humidity), inconsistent electricity and falsification of uterotonics. WHO, in its 2018 Recommendations, surmised heat-stable uterotonic agents may be more suitable options, depending on the context. This study evaluates the cost-effectiveness and budget impact of heat-stable carbetocin (HSC) compared to other uterotonic options for PPH prophylaxis. Methods This is a health-economic evaluation to compare the occurrence of PPH events, costs, and the cost-effectiveness of introducing heat-stable carbetocin versus oxytocin+/-misoprostol for PPH prevention among women delivering in public healthcare facilities in Nigeria. The study utilized a hierarchical decision-tree model, developed from the public healthcare system perspective, that had as inputs demographical, clinical, and economical information, and generated results related to PPH events (categorized as mild-moderate and severe), PPH-related deaths, DALYs (disability adjusted life-years) on account of PPH and PPH-related direct costs to the healthcare system. Results The cost-effectiveness analysis revealed that in a cohort of 2,548,136 deliveries in Nigeria, HSC can avert 111,652 PPH events, 12,873 severe PPH events, 31,442 DALYs, and 1,165 deaths when compared against oxytocin, at a 4.5% reduction in total cost to the health system. Similar favorable results are associated with heat-stable carbetocin when compared with misoprostol and oxytocin-misoprostol combination. The budget impact analysis revealed that HSC can lead to total cumulative savings of USD $325,114 (₦ 240,743,2931) if scaled up over a 5-year period to 17% market share of prophylactic uterotonics administered in the country. Conclusions Introduction of HSC for PPH prevention is a cost-effective public health intervention in Nigeria. Health-economic modeling projects HSC to be associated with lower costs to the health system while conferring better maternal health outcomes when compared to oxytocin, misoprostol, or oxytocin-misoprostol combination. [1] At a CBN rate of ₦740.49 to 1 USD (accessed 01/09/2023)

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Cost-effectiveness and budget impact of heat-stable carbetocin compared to oxytocin and misoprostol for the prevention of postpartum hemorrhage (PPH) in women giving birth in India

Cited by 4 publications

References 25 publications

Modeling the economic burden of postpartum hemorrhage due to substandard uterotonics in Ghana

Modeling the economic burden of postpartum hemorrhage due to substandard uterotonics in Ghana

The cost-effectiveness of preventing, diagnosing, and treating postpartum haemorrhage: A systematic review of economic evaluations

A Cost-Effectiveness and Budget Impact Analysis of the Introduction of Heat Stable Carbetocin for Postpartum Hemorrhage Prevention in Nigeria

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