ECONOMIC EVALUATION OF OXYTOCIN IN UNIJECT INJECTION SYSTEM VERSUS STANDARD USE OF OXYTOCIN FOR THE PREVENTION OF POSTPARTUM HEMORRHAGE IN LATIN AMERICA AND THE CARIBBEAN
Author(s)
Pichon riviere A1, Glujovsky D2, Garay OU3, Augustovski F3, Ciapponi A2, Serpa M4
1Health Economic Evaluations and Technology Assessment at the Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina, 2Institute for Clinical Effectiveness and Health Policy (IECS), CABA, Argentina, 3Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina, 4Maternal and Child Health Integrated Program, PATH-, Washington, DC, USA
OBJECTIVES: Postpartum hemorrhage (PPH) is a leading cause of maternal death. Although the strong evidence showing the efficacy of oxytocin in preventing PPH, its use 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). This study objective is to evaluate the cost-effectiveness of OiU in Latin America (LAC). METHODS: We built an epidemiological model 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 cost-effective strategy ranged from 1.3% in Suriname to 16.2% 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 showed to be cost saving. In the remaining 21 countries OiU was associated with a net cost increment ($ 0.005 to $0.780 2013 US dollars per delivery). OiU strategy ranged from being dominant to having an ICER of $ 9,454 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 showed to be robust in the sensitivity analysis under a wide range of assumptions and scenarios.
Conference/Value in Health Info
2014-05, ISPOR 2014, Palais des Congres de Montreal
Value in Health, Vol. 17, No. 3 (May 2014)
Code
PIH34
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Reproductive and Sexual Health