Uterotonic drugs for the prevention of postpartum haemorrhage: a cost-effectiveness analysis

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Abstract

Objective
The objective of this study is to estimate the relative cost-effectiveness for the full range of uterotonic drugs available for preventing postpartum haemorrhage (PPH).

Methods
A model-based economic evaluation was constructed using effectiveness data from a network meta-analysis, and supplemented by the literature. A UK National Health Service (NHS) perspective was adopted for the analysis which is based on UK costs from published sources. The primary outcome measure is cost per case of PPH avoided (≥500mL blood loss), with secondary outcome measures of cost per case of severe PPH avoided (≥1000mL) and cost per major outcome (surgery) averted also being analysed.

Results
Carbetocin is shown to be the most effective strategy. Excluding adverse events, ‘ergometrine plus oxytocin’ was shown to be the least costly strategy. The incremental cost-effectiveness ratio for prevention of PPH with carbetocin compared to prevention with ‘ergometrine plus oxytocin’ was £1,889 per case of PPH ≥ 500mL avoided; £30,013 per case of PPH ≥ 1000mL avoided; and £1,172,378 per major outcome averted.

Including adverse events in the analysis showed oxytocin to be the least costly strategy. The incremental cost-effectiveness ratio for prevention of PPH with carbetocin compared to prevention with oxytocin was £928 per case of PPH ≥ 500mL avoided; £22,900 per case of PPH ≥ 1000mL avoided; and £894,514 per major outcome averted.

Conclusion
The results suggest carbetocin, oxytocin and ‘ergometrine plus oxytocin’ could all be favourable options for being the most cost-effective strategy for preventing PPH. Carbetocin could be the preferred choice, especially if the price of carbetocin decreased. Mixed findings mean a clear-cut conclusion cannot be made as to which uterotonic is the most cost-effective. Future research should focus on collecting more robust evidence on the probability of suffering adverse events from the uterotonic drugs, and on adapting the model for low and middle income countries.

Key Points for Decision Makers
1. This cost-effectiveness analysis is the first analysis to analyse the relative cost-effectiveness for the full range of uterotonic drugs available for preventing postpartum haemorrhage.
2. The results of this paper show carbetocin, oxytocin and ‘ergometrine plus oxytocin’ to all be favourable options for the prevention of postpartum haemorrhage.
3. A small decrease in the price of carbetocin could make it the preferred uterotonic for preventing postpartum haemorrhage.

Details

Original languageEnglish
Pages (from-to)1-14
JournalPharmacoEconomics
Publication statusPublished - 30 Nov 2018