Abstract
ObjectivePost-partum hemorrhage (PPH) is the leading direct cause of maternal mortality in India. Uterine balloon tamponade (UBT) is recommended for atonic PPH cases not responding to uterotonics. This study assessed cost-effectiveness of three UBT devices used in Indian public health settings.MethodsA decision tree model was built to assess cost-effectiveness of Bakri-UBT and low-cost ESM-UBT alternatives as compared to the recommended standard of care i.e. condom-UBT intervention. A hypothetical annual cohort of women eligible for UBT intervention after experiencing atonic PPH in Indian public health facilities were evaluated for associated costs and outcomes over life-time horizon using a disaggregated societal perspective. Costs by undertaking primary costing and clinical parameters from published literature were used. Incremental cost per Disability Adjusted Life Years (DALY) averted, number of surgeries and maternal deaths with the interventions were estimated. An India specific willingness to pay threshold of INR 24,211 (USD 375) was used to evaluate cost-effectiveness. Detailed sensitivity analysis and expected value of information analysis was undertaken.ResultsESM-UBT at base-case Incremental Cost-Effectiveness Ratio (ICER) of INR -2,412 (USD 37) per DALY averted is a cost-saving intervention i.e. is less expensive and more effective as compared to condom-UBT. Probabilistic sensitivity analysis however shows an error probability of 0.36, indicating a degree of uncertainty around model results. Bakri-UBT at an ICER value of INR -126,219 (USD -1,957) per DALY averted incurs higher incremental societal costs and is less effective as compared to condom-UBT. Hence, Bakri-UBT is not cost-effective.ConclusionFor atonic PPH management in India, condom-UBT offers better value as compared to Bakri-UBT. Given the limited clinical effectiveness evidence and uncertainty in sensitivity analysis, cost-saving result for ESM-UBT must be considered with caution. Future research may focus on generating high quality comparative clinical evidence for UBT devices to facilitate policy decision making.
Highlights
Investment in maternal health improves health outcomes and substantially benefits overall socio-economic development of the society [1,2,3]
Data Availability Statement: The data underlying the results presented in the study are available from the Director, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Mumbai who may be contacted at dir@nirrh.res.in, due to third party restrictions
Cost-effectiveness of uterine balloon tamponade in atonic Post-partum hemorrhage (PPH) management the Director, NIRRH that was further allocated to the principal investigator BNJ
Summary
Investment in maternal health improves health outcomes and substantially benefits overall socio-economic development of the society [1,2,3]. Though maternal health financing towards life-saving interventions has steadily improved over time, key factors like sustainable and efficient funding, pertinent health policies and a reliable supply of life saving commodities ensuring coverage of health services has still fallen short [4]. Efficient use of available resources by implementing cost-effective interventions can prevent maternal morbidity and mortality. Obstetric hemorrhage is the leading direct cause of maternal deaths worldwide. Timely referrals, availability of emergency obstetric services and a reliable supply of life-saving commodities can avoid these deaths occurring due to PPH [3, 7]
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