OBJECTIVES: Postpartum hemorrhage is one of the complications after vaginal and cesarean delivery which can make a life-threatening situation. The incidence of PPH is about 6 percent of all the births which causes approximately a quarter of global maternal deaths. Several studies have been conducted to evaluate the effectiveness of approved drugs for management of PPH. Some contradictory conclusions about the effectiveness of this drugs have been reported. This study is aimed to review the randomized clinical trials systematically, calculate the efficacy through the meta-analysis, and assess the cost-utility of Carbetocin versus Oxytocin in the context of Iran. METHODS: For collecting clinical data, databases were systematically searched for RCTs in which Carbetocin was compared to other uterotonic agents to prevent PPH between years 1999 and 2015. Expert opinion was also attained to obtain a consensus between local practice and subsequently the international guidelines. The pharmacoeconomics method used in this study is “Cost-Utility Analysis” which is performed in a decision tree model. Direct Medical costs were calculated based on the public and private tariffs in the year 2015. The human capital approach was applied for estimating indirect costs. Societal and health-care-system perspectives are used in this study, and one year time frame is preferred based on the nature of the disease. RESULTS: By using health-care-system perspective, the main result is that Carbetocin is dominantly cost-effective versus oxytocin in the best-case scenario in which the maximum price of Oxytocin and other costs are considered in private sector. The ICER in this scenario is -104,696 USD/QALY. Similarly, considering the societal perspective, Carbetocin is cost-effective, and the calculated ICER is -133,298 USD/QALY. CONCLUSIONS: Although Carbetocin is not cost-effective in other scenarios, the total extra cost which is imposed by using Carbetocin is not significant, (12,300 – 21,400 USD) because of the a few number of candidates for this drug.