Presentation (CTI)

OBJECTIVES: To compare the cost-utility of the Pritchard and Zuspan magnesium sulphate regimens for the management of severe pre-eclampsia using real-world data from two hospitals in West Africa over a 12-month period.
METHODS: A model-based cost-utility analysis was conducted alongside a retrospective observational study in two hospitals: a secondary-level hospital using the intramuscular Pritchard regimen and a tertiary-level hospital using the intravenous Zuspan regimen. Overall, 416 women with severe pre-eclampsia were included (156 secondary, 260 tertiary). The analysis adopted a healthcare provider perspective from admission to discharge. A decision-analytic model incorporated probabilities of seizure prevention, magnesium toxicity, and survival to discharge. Direct medical costs were derived from hospital records, including drugs, consumables, monitoring, and personnel time. Outcomes were measured as quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios were estimated, and uncertainty assessed overall.
RESULTS: Both magnesium sulphate regimens effectively prevented progression to eclampsia, with no meaningful differences in seizure occurrence or survival to discharge between hospitals. The Pritchard regimen used at the secondary-level hospital had a lower mean cost per patient, mainly due to reduced use of infusion equipment, laboratory monitoring, and continuous nursing supervision. Although the Zuspan regimen at the tertiary hospital produced slightly higher QALYs, the incremental health gains were minimal and did not justify the higher costs. Overall, the Pritchard regimen was cost-saving with comparable outcomes and therefore dominated the Zuspan regimen. Sensitivity analyses supported the robustness of these results.
CONCLUSIONS: Over a 12-month period in two hospitals in West Africa, the Pritchard magnesium sulphate regimen implemented at a secondary-level facility was more cost-effective than the Zuspan regimen implemented at a tertiary-level facility for the management of severe pre-eclampsia. These findings support the continued use of the Pritchard regimen in resource-limited settings and provide specific economic evidence to inform obstetric care policies and clinical guidelines.