Abstract
Recent World Health Organization (WHO) recommendations regarding uterotonics for the prevention of postpartum hemorrhage (PPH) state that carbetocin should be considered a first-line prophylactic agent for all births where its cost is comparable to other effective uterotonics. This study evaluated whether a room temperature stable formulation of carbetocin met this recommendation in a Canadian urban hospital setting. A decision tree model was developed to assess the financial implications of replacing oxytocin with carbetocin as a first-line prophylactic agent for PPH prevention in a Greater Toronto Area (GTA) hospital. The analysis accounted for the mode of delivery, efficacies of carbetocin and oxytocin in PPH prevention, occurrence of PPH-related health outcomes, and health care resource costs for PPH interventions. This study found that a GTA hospital, with 3242 deliveries per year, could save over CAD $349000 annually by switching to room temperature stable carbetocin for PPH prevention. Carbetocin was able to lower institution costs by reducing the use of health care resources for PPH management in low-risk and high-risk PPH patients. The cost-saving potential of carbetocin relative to oxytocin was largely attributed to its greater efficacy in preventing the consequences of PPH. The use of room temperature stable carbetocin as a first-line prophylactic agent for PPH prevention meets WHO recommendations regarding uterotonics for PPH in a GTA hospital. The model from this study can be used to determine the financial impact of switching from oxytocin to carbetocin in other jurisdictions while diversifying a hospital's pool of PPH prophylactic agents.
Highlights
Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide and occurs in 5% of all deliveries.[1]
Cost Implication Analysis Based on the actual cohort of 3,242 patients, a Canadian Greater Toronto Area (GTA) hospital would save over $349,000 Canadian dollars (CAD) in institution costs by replacing oxytocin with carbetocin for postpartum hemorrhage (PPH) prevention
Total costs associated with the three active PPH health outcomes decreased with carbetocin use, the total cost of the no PPH health outcome increased with carbetocin use (Table 3)
Summary
Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide and occurs in 5% of all deliveries.[1]. 1,2,6 a recent network meta-analysis (NMA) of uterotonic agents suggests that, relative to oxytocin, carbetocin might be more effective for PPH prevention.[3] despite the higher drug cost of carbetocin, an economic study in the United Kingdom reported that carbetocin might be more cost-effective than oxytocin due to the reduced use of healthcare resources.[3,6] carbetocin may be a cost-effective first-line prophylactic agent for PPH prevention in Canada
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