Oral versus intravenous iron for anemia in pregnancy: a cost-effectiveness analysis.

Our findings suggest that treating antepartum anemia with currently available iron therapies would result in significant cost-savings and reductions in adverse outcomes associated with anemia in this context. Ferric carboxymaltose likely confers the greatest overall benefit among competing options. This conclusion is robust to uncertainty, even when the cost these therapies is significantly higher than is demonstrated in the literature.

Pregnancy and newborn health - heat impacts and emerging solutions.

Evidence is accumulating, both in the US and abroad, of the apparent serious health impacts of various environmental exposures tied to climate change. High ambient temperature, or heat, is a worsening global health risk. Heat risk is affected by many factors such as the magnitude, duration, and timing of exposure - such as specific, critical windows during pregnancy. This article focuses on the association of heat with both adverse pregnancy and newborn health outcomes. Regarding pregnancy, studies link heat and preterm birth, low birth weight and stillbirth. Multiple potential mechanisms support the biological plausibility of these associations. Emerging evidence suggests that heat, via epigenetics, may affect maternal health far beyond pregnancy. For newborn health impacts, heat is associated with increased hospitalization, neurologic and gastrointestinal dysfunction, and infant death. Research gaps include the need to study neonates separately from children and determining the mechanisms linking heat to adverse outcomes. We also highlight disparate adverse reproductive health outcomes for communities of color and low income tied to disproportionate exposures to environmental stressors like heat. Finally, we summarize educational and clinical tool resources for clinicians, information for patients, and opportunities for near-term action using the precautionary principle framework.

Tranexamic acid for the prevention of postpartum hemorrhage: a cost-effectiveness analysis.

Postpartum hemorrhage is a significant contributor to maternal mortality worldwide and in the United States. Tranexamic acid (TXA) has been shown to reduce PPH complications although it is not routinely recommended for use as prophylaxis to date. To estimate the cost-effectiveness of alternative risk-dictated strategies utilizing prophylactic tranexamic acid for the prevention of postpartum hemorrhage. We constructed a microsimulation-based Markov decision-analytic model estimating the cost-effectiveness of three alternative risk-dictated strategies for tranexamic acid prophylaxis versus the no prophylaxis in a cohort of 3.8 million pregnant women delivering in the United States. Each strategy differentially modified risk-specific hemorrhage probabilities by preliminary estimates of tranexamic acid's prophylactic efficacy. Outcome measures included incremental costs, quality-adjusted life-years, and outcomes averted. Costs and benefits were considered from the healthcare system and societal perspectives over a lifetime time horizon. All intervention strategies were dominant versus no prophylaxis, implying that they were simultaneously more effective and cost-saving. Prophylaxing delivering women irrespective of hemorrhage risk produced the most favorable results overall, with estimated cost savings greater than $690 million and up to 149,505 PPH cases, 2,933 hysterectomies, and 70 maternal deaths averted, per annual cohort. Threshold analysis suggested that tranexamic acid is likely to be cost-saving for health systems at costs below $190 per gram. Our findings suggest that routine prophylaxis with tranexamic acid would likely result in substantial cost-savings and reductions in adverse maternal outcomes in this context. This study is a cost-effectiveness analysis demonstrating cost-savings and reduction in adverse maternal outcomes with routine tranexamic acid as prophylaxis for post-partum hemorrhage.