Cost‐effectiveness of uterine tamponade devices for the treatment of postpartum hemorrhage: A systematic review

Joshua P Vogel,Mariana Widmer,Nick Scott,Olufemi T Oladapo,Fernando Althabe,Alyce N Wilson

doi:10.1002/ijgo.13393

Abstract

BackgroundUterine tamponade is widely promoted for treating refractory postpartum hemorrhage (PPH); however, its cost‐effectiveness may vary depending on unit costs and setting.ObjectiveTo review available data on cost‐effectiveness of uterine tamponade devices when used for PPH treatment.Search strategyPubMed and EMBASE were searched (1980 to January 2020), as well as the National Health Services Economic Evaluation database from inception (1995) to March 2015.Selection criteriaEligible studies were any type of economic evaluation, or effectiveness studies that provided cost or economic data.Data collection and analysisTwo reviewers independently screened studies, extracted data, and assessed quality.Main resultsEleven studies using a range of devices (condom catheter, uterine suction devices, Bakri, Inpress, Ellavi) were identified. Cost of condom catheter devices or kits ranged from US$0.64 to US$6, whereas purpose‐designed device costs were up to US$400. Two studies that took a health system perspective assessed the cost‐effectiveness of using uterine balloon tamponade and suggested that it was highly cost‐effective because of the low cost per disability‐adjusted life‐year averted, although both used effect estimates from case series.ConclusionsEvidence on the cost‐effectiveness of uterine tamponade devices was limited and not generalizable. Rigorous economic evaluations based on updated effect estimates are needed.

Highlights

Obstetric hemorrhage is the leading cause of maternal mortality, con‐ tributing to 27.1% of maternal deaths worldwide.[1]
We developed a search strategy and on January 15, 2020 searched PubMed (January 1, 1980 to date of search), EMBASE (January 1, 1980) and the National Health Services Economic Evaluation (NHS EED) database
The two cost‐effectiveness analyses indicated that UBT using con‐ dom catheter is highly cost‐effective from a health system perspec‐ tive, but both studies used effect estimates derived from case series with relatively small sample sizes

Summary

Introduction

Obstetric hemorrhage is the leading cause of maternal mortality, con‐ tributing to 27.1% (uncertainty interval 19.9%–36.2%) of maternal deaths worldwide.[1]. WHO’s 2012 guidelines on PPH prevention and management recommended that if a woman with PPH due to uterine atony does not respond to treatment using uterotonics (i.e., refractory PPH), or if uterotonics are unavailable, UBT should be used (weak rec‐ ommendation, very‐low‐quality evidence).[5] In this situation, trained, skilled health personnel insert a balloon catheter inside the uterus that (when filled) applies hydrostatic pressure to reduce blood flow and facilitate clotting. Objective: To review available data on cost‐effectiveness of uterine tamponade devices when used for PPH treatment. Two studies that took a health system perspective assessed the cost‐ effectiveness of using uterine balloon tamponade and suggested that it was highly cost‐ effective because of the low cost per disability‐adjusted life‐year averted, both used effect estimates from case series. Rigorous economic evaluations based on updated effect estimates are needed

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