Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings

Abstract Background Access to oxytocin for prevention of postpartum haemorrhage (PPH) in resource-poor settings is limited by the requirement for a consistent cold chain and for a skilled attendant to administer the injection. To overcome these barriers, heat-stable, non-injectable formulations of o...

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Main Authors: Natalie Carvalho, Mohammad Enamul Hoque, Victoria L. Oliver, Abbey Byrne, Michelle Kermode, Pete Lambert, Michelle P. McIntosh, Alison Morgan
Format: Article
Language:English
Published: BMC 2020-07-01
Series:BMC Medicine
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12916-020-01658-y
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spelling doaj-ddfcba6b16ae4a8c87c263316cc00bda2020-11-25T03:35:34ZengBMCBMC Medicine1741-70152020-07-0118111810.1186/s12916-020-01658-yCost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settingsNatalie Carvalho0Mohammad Enamul Hoque1Victoria L. Oliver2Abbey Byrne3Michelle Kermode4Pete Lambert5Michelle P. McIntosh6Alison Morgan7Centre for Health Policy & Global Burden of Disease Group, School of Population and Global Health, The University of MelbourneAgency for Clinical Innovation, NSW Ministry of HealthDrug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash UniversityDrug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash UniversityNossal Institute for Global Health, Melbourne School of Population and Global Health, University of MelbourneDrug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash UniversityDrug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash UniversityNossal Institute for Global Health, Melbourne School of Population and Global Health, University of MelbourneAbstract Background Access to oxytocin for prevention of postpartum haemorrhage (PPH) in resource-poor settings is limited by the requirement for a consistent cold chain and for a skilled attendant to administer the injection. To overcome these barriers, heat-stable, non-injectable formulations of oxytocin are under development, including oxytocin for inhalation. This study modelled the cost-effectiveness of an inhaled oxytocin product (IHO) in Bangladesh and Ethiopia. Methods A decision analytic model was developed to assess the cost-effectiveness of IHO for the prevention of PPH compared to the standard of care in Bangladesh and Ethiopia. In Bangladesh, introduction of IHO was modelled in all public facilities and home deliveries with or without a skilled attendant. In Ethiopia, IHO was modelled in all public facilities and home deliveries with health extension workers. Costs (costs of introduction, PPH prevention and PPH treatment) and effects (PPH cases averted, deaths averted) were modelled over a 12-month program. Life years gained were modelled over a lifetime horizon (discounted at 3%). Cost of maintaining the cold chain or effects of compromised oxytocin quality (in the absence of a cold chain) were not modelled. Results In Bangladesh, IHO was estimated to avert 18,644 cases of PPH, 76 maternal deaths and 1954 maternal life years lost. This also yielded a cost-saving, with the majority of gains occurring among home deliveries where IHO would replace misoprostol. In Ethiopia, IHO averted 3111 PPH cases, 30 maternal deaths and 767 maternal life years lost. The full IHO introduction program bears an incremental cost-effectiveness ratio (ICER) of between 2 and 3 times the per-capita Gross Domestic Product (GDP) ($1880 USD per maternal life year lost) and thus is unlikely to be considered cost-effective in Ethiopia. However, the ICER of routine IHO administration considering recurring cost alone falls under 25% of per-capita GDP ($175 USD per maternal life-year saved). Conclusions IHO has the potential to expand access to uterotonics and reduce PPH-associated morbidity and mortality in high burden settings. This can facilitate reduced spending on PPH management, making the product highly cost-effective in settings where coverage of institutional delivery is lagging.http://link.springer.com/article/10.1186/s12916-020-01658-yMaternal healthGlobal healthSustainable development goalsHeat-stable uterotonicsHealth economic analysisEthiopia
collection DOAJ
language English
format Article
sources DOAJ
author Natalie Carvalho
Mohammad Enamul Hoque
Victoria L. Oliver
Abbey Byrne
Michelle Kermode
Pete Lambert
Michelle P. McIntosh
Alison Morgan
spellingShingle Natalie Carvalho
Mohammad Enamul Hoque
Victoria L. Oliver
Abbey Byrne
Michelle Kermode
Pete Lambert
Michelle P. McIntosh
Alison Morgan
Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings
BMC Medicine
Maternal health
Global health
Sustainable development goals
Heat-stable uterotonics
Health economic analysis
Ethiopia
author_facet Natalie Carvalho
Mohammad Enamul Hoque
Victoria L. Oliver
Abbey Byrne
Michelle Kermode
Pete Lambert
Michelle P. McIntosh
Alison Morgan
author_sort Natalie Carvalho
title Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings
title_short Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings
title_full Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings
title_fullStr Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings
title_full_unstemmed Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings
title_sort cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings
publisher BMC
series BMC Medicine
issn 1741-7015
publishDate 2020-07-01
description Abstract Background Access to oxytocin for prevention of postpartum haemorrhage (PPH) in resource-poor settings is limited by the requirement for a consistent cold chain and for a skilled attendant to administer the injection. To overcome these barriers, heat-stable, non-injectable formulations of oxytocin are under development, including oxytocin for inhalation. This study modelled the cost-effectiveness of an inhaled oxytocin product (IHO) in Bangladesh and Ethiopia. Methods A decision analytic model was developed to assess the cost-effectiveness of IHO for the prevention of PPH compared to the standard of care in Bangladesh and Ethiopia. In Bangladesh, introduction of IHO was modelled in all public facilities and home deliveries with or without a skilled attendant. In Ethiopia, IHO was modelled in all public facilities and home deliveries with health extension workers. Costs (costs of introduction, PPH prevention and PPH treatment) and effects (PPH cases averted, deaths averted) were modelled over a 12-month program. Life years gained were modelled over a lifetime horizon (discounted at 3%). Cost of maintaining the cold chain or effects of compromised oxytocin quality (in the absence of a cold chain) were not modelled. Results In Bangladesh, IHO was estimated to avert 18,644 cases of PPH, 76 maternal deaths and 1954 maternal life years lost. This also yielded a cost-saving, with the majority of gains occurring among home deliveries where IHO would replace misoprostol. In Ethiopia, IHO averted 3111 PPH cases, 30 maternal deaths and 767 maternal life years lost. The full IHO introduction program bears an incremental cost-effectiveness ratio (ICER) of between 2 and 3 times the per-capita Gross Domestic Product (GDP) ($1880 USD per maternal life year lost) and thus is unlikely to be considered cost-effective in Ethiopia. However, the ICER of routine IHO administration considering recurring cost alone falls under 25% of per-capita GDP ($175 USD per maternal life-year saved). Conclusions IHO has the potential to expand access to uterotonics and reduce PPH-associated morbidity and mortality in high burden settings. This can facilitate reduced spending on PPH management, making the product highly cost-effective in settings where coverage of institutional delivery is lagging.
topic Maternal health
Global health
Sustainable development goals
Heat-stable uterotonics
Health economic analysis
Ethiopia
url http://link.springer.com/article/10.1186/s12916-020-01658-y
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