Theresa A Lawrie1,2, Ewelina Rogozińska2, Pauline Sobiesuo3, Joshua P Vogel1,4, Laura Ternent3, Olufemi T Oladapo1. 1. Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland. 2. Evidence-Based Medicine Consultancy Ltd, Bath, UK. 3. Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK. 4. Maternal and Child Health, Burnet Institute, Melbourne, Vic., Australia.
Abstract
BACKGROUND: Several uterotonic options exist for prevention of postpartum hemorrhage (PPH); hence, cost-effectiveness is an important decision-making criterion affecting uterotonic choice. OBJECTIVE: To conduct a systematic review of cost-effectiveness of uterotonics for PPH prevention to support a WHO guideline update. SEARCH STRATEGY: We searched major databases from 1980 to June 2018 and the National Health Services Economic Evaluation (NHS EED) database from inception (1995) to March 2015 for eligible studies. SELECTION CRITERIA: We included comparative economic evaluations, cost-utility analyses, and resource-utilization studies. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies and extracted data organized by birth mode and setting. MAIN RESULTS: We included 15 studies across all income categories that compared misoprostol versus no uterotonic (five studies) or versus oxytocin (one study), carbetocin versus oxytocin (eight studies), and one study comparing numerous uterotonics. In specific low-resource contexts, we found reasonably good evidence that misoprostol was cost-effective compared with no uterotonic. In the context of cesarean delivery, carbetocin was more cost favorable than oxytocin but certainty of this evidence was low. CONCLUSIONS: Evidence on the cost-effectiveness of various uterotonic agents was not generalizable. As the number of competing uterotonics increases, rigorous economic evaluations including contextual factors are needed.
BACKGROUND: Several uterotonic options exist for prevention of postpartum hemorrhage (PPH); hence, cost-effectiveness is an important decision-making criterion affecting uterotonic choice. OBJECTIVE: To conduct a systematic review of cost-effectiveness of uterotonics for PPH prevention to support a WHO guideline update. SEARCH STRATEGY: We searched major databases from 1980 to June 2018 and the National Health Services Economic Evaluation (NHS EED) database from inception (1995) to March 2015 for eligible studies. SELECTION CRITERIA: We included comparative economic evaluations, cost-utility analyses, and resource-utilization studies. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies and extracted data organized by birth mode and setting. MAIN RESULTS: We included 15 studies across all income categories that compared misoprostol versus no uterotonic (five studies) or versus oxytocin (one study), carbetocin versus oxytocin (eight studies), and one study comparing numerous uterotonics. In specific low-resource contexts, we found reasonably good evidence that misoprostol was cost-effective compared with no uterotonic. In the context of cesarean delivery, carbetocin was more cost favorable than oxytocin but certainty of this evidence was low. CONCLUSIONS: Evidence on the cost-effectiveness of various uterotonic agents was not generalizable. As the number of competing uterotonics increases, rigorous economic evaluations including contextual factors are needed.
Authors: Maria Fernanda Escobar; Anwar H Nassar; Gerhard Theron; Eythan R Barnea; Wanda Nicholson; Diana Ramasauskaite; Isabel Lloyd; Edwin Chandraharan; Suellen Miller; Thomas Burke; Gabriel Ossanan; Javier Andres Carvajal; Isabella Ramos; Maria Antonia Hincapie; Sara Loaiza; Daniela Nasner Journal: Int J Gynaecol Obstet Date: 2022-03 Impact factor: 4.447
Authors: Joshua P Vogel; Therese Dowswell; Simon Lewin; Mercedes Bonet; Lynn Hampson; Frances Kellie; Anayda Portela; Maurice Bucagu; Susan L Norris; James Neilson; Ahmet Metin Gülmezoglu; Olufemi T Oladapo Journal: BMJ Glob Health Date: 2019-08-19
Authors: Joshua P Vogel; Alyce N Wilson; Nick Scott; Mariana Widmer; Fernando Althabe; Olufemi T Oladapo Journal: Int J Gynaecol Obstet Date: 2020-10-30 Impact factor: 3.561