OBJECTIVES: To compare the clinical effectiveness and cost-effectiveness of carbetocin with oxytocin for preventing postpartum hemorrhage. METHODS: The literature search and systematic review included Ovid MEDLINE, Cochrane Library Database, Embase, TRIP Database, Scopus, CINAHL databases. Systematic The Markov microsimulation model for hypothetical cohort of patients was developed to define a preventing postpartum hemorrhage, illustrate the current costs of treating patients with the condition, with direct health-care cost perspective. RESULTS: Studies comparing carbetocin with oxytocin in women undergoing vaginal delivery demonstrated no statistical difference in terms of risk of postpartum hemorrhage, severe postpartum hemorrhage or the risk of adverse effect, but the need for additional uterotonic agents was significantly lower in the carbetocin group (RR = 0.65, 95% CI: 0.54 to 0.86). However, the total cost of treatment was higher for carbetocin compared with oxytocin, approximately 25.7 times, from the position of the perspective of Kazakhstan healthcare payer. The probability for carbetocin being cost-effective did not exceed 50% for any value of willingness to pay for effect. CONCLUSIONS: Our analysis failed to detect a significant difference with respect to postpartum hemorrhage, severe postpartum hemorrhage, mean estimated blood loss and adverse effects between carbetocin and oxytocin. Carbetocin does not seem to be a cost-effective strategy as compared with oxytocin for postpartum haemorrhage. Additional, higher-volume studies examining the clinical effect would be valuable.