Economic evaluation of oxytocin in uniject injection system versus standard use of oxytocin for the prevention of postpartum hemorrhage in the active management of the third stage of labor in Latin America and the Caribbean

ABSTRACT

BACKGROUND: Postpartum hemorrhage (PPH) is a leading cause of maternal death. Despite strong evidence showing the efficacy of oxytocin in preventing PPH, use of the drug for this purpose remains suboptimal. The Uniject injection system prefilled with oxytocin (OiU) has the potential advantage, due to its ease of use, to increase oxytocin coverage rates (OCR). OBJECTIVES: To evaluate the cost-effectiveness of OiU in Latin America and the Caribbean (LAC). METHODS: An epidemiological model was built to estimate the impact of replacing oxytocin in ampoules with OiU on the incidence of PPH, quality-adjusted life years (QALYs), and costs, from a health care perspective. A systematic search for data on epidemiology and cost studies was undertaken. A consensus panel among LAC experts was performed to quantify the expected increase in OCR as a consequence of making OiU available. Deterministic and probabilistic sensitivity analyses were performed. RESULTS In the threshold analysis the minimum required increment in the OCR to make OiU a costeffective strategy ranged from 1.3% in Suriname to 15.8% in Haiti. In more than 60% of the countries, the required increment was below 5%. OiU could prevent more than 40,000 PPH episodes annually in LAC. In 27% of the countries, OiU was found to be cost saving. In the remaining 22 countries, OiU was associated with a net cost increment (0.005 to 0.847 2013 US dollars per delivery). OiU strategy ranged from being dominant to having an incremental costeffectiveness ratio (ICER) of US$ 8,990 per QALY gained. In the great majority of countries these ICERs were below one GDP per capita. CONCLUSIONS OiU was cost-saving or very cost-effective in almost all countries. Even if countries can achieve only small increases in OCR by incorporating OiU, this strategy could be considered an efficient use of resources. These results were robust in the sensitivity analysis under a wide range of assumptions and scenarios. (AU)