Abstract
BackgroundThe World Health Organization (WHO) recommends oxytocin as the drug of choice for postpartum hemorrhage (PPH) prevention. However, the WHO has also recently considered carbetocin for PPH prevention, but only if carbetocin were a cost-effective choice in the country. Consequently, we determined the cost-effectiveness and budgetary impact of carbetocin against oxytocin in the Philippines.MethodsA cost-utility analysis using a decision tree was done to compare the costs and outcomes of carbetocin with oxytocin for PPH prophylaxis among women undergoing either vaginal delivery (VD) or cesarean section (CS) in a six-week time horizon using a societal perspective. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Additionally, budget impact analysis was conducted using a governmental perspective. Results were presented as incremental cost-effectiveness ratio (ICER) using a 2895 United States dollar (USD) per quality adjusted life year (QALY) gained as the ceiling threshold in the Philippines.ResultsCarbetocin was not cost-effective given the listed price of carbetocin at 18 USD. Given a societal perspective, the ICER values of 13,187 USD and over 40,000 USD per QALY gained were derived for CS and VD, respectively. Moreover, the ICER values were sensitive to the risk ratio of carbetocin versus oxytocin and carbetocin price. On budget impact, the five-year total budget impact of a drug mix of carbetocin and oxytocin was 25.54 million USD (4.23 million USD for CS and 21.31 million USD for VD) compared with ‘only oxytocin’ scenario.ConclusionCarbetocin is not a cost-effective choice in PPH prevention for both modes of delivery in the Philippines, unless price reduction is made. Our findings can be used for evidence-informed policies to guide coverage decisions on carbetocin not only in the Philippines but also in other low and middle-income countries.
Highlights
The World Health Organization (WHO) recommends oxytocin as the drug of choice for postpartum hemorrhage (PPH) prevention
Cost-effectiveness analysis For women giving birth through cesarean section (CS), incremental cost and incremental quality adjusted life year (QALY) of carbetocin compared with oxytocin were 13.19 United States dollar (USD) and 0.001 QALYs, resulting in the incremental cost-effectiveness ratio (ICER) value of 13,187 USD per QALY gained
For those in vaginal delivery (VD), incremental cost and incremental QALY of carbetocin were 17.49 USD and 0.000405 QALYs, leading to the ICER value of 43,164 USD per QALY gained compared with oxytocin
Summary
The World Health Organization (WHO) recommends oxytocin as the drug of choice for postpartum hemorrhage (PPH) prevention. Postpartum hemorrhage (PPH) remains as the leading cause of maternal morbidity and mortality worldwide. PPH is defined as a blood loss of more than 500 mL in vaginal delivery (VD) or more than 1000 mL in cesarean section (CS) and may lead to sequelae such as massive blood transfusion, ICU admission, or in extreme cases, hysterectomy [4,5,6,7]. It is unpredictable as it occurs without identifiable clinical or historical risk factors. AMTSL has three components: (1) administration of prophylactic uterotonic, (2) controlled cord traction, and (3) uterine massage, where emphasis is given to the use of a prophylactic uterotonic drug as it reduces the risk of PPH by 66% compared with the other two components [9,10,11]
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