Prevention of postpartum XXXX : cost consequences analysis of @entity396 in low-resource settings.

@entity398 @entity1 @entity396 @entity548
BACKGROUND: While inferior to @entity398 injection in both efficacy and safety, orally administered @entity396 has been included in the World Health Organization Model List of Essential Medicines for use in the prevention of postpartum @entity548 (PPH) in low-resource settings. This study evaluates the costs and health outcomes of use of oral @entity396 to prevent PPH in settings where injectable uterotonics are not available. METHODS: A cost-consequences analysis was conducted from the international health system perspective, using data from a recent Cochrane systematic review and WHO's Mother-Baby Package Costing Spreadsheet in a hypothetical cohort of 1000 births in a mixed hospital (40  % births)/community setting (60  % births). Costs were estimated based on 2012 US dollars. RESULTS: Using @entity398 in the hospital setting and @entity396 in the community setting in a cohort of 1000 births, instead of @entity398 (hospital setting) and no treatment (community setting), 22 cases of PPH could be prevented. Six fewer @entity1 would require additional uterotonics and four fewer @entity1 a blood transfusion. An additional 130 @entity1 would experience shivering and an extra 42 @entity1 fever. @entity398 / @entity396 was found to be cost saving (US 320) compared to @entity398 /no treatment. If @entity396 is used in both the hospital and community setting compared with no treatment (i.e. @entity398 not available in the hospital setting), 37 cases of PPH could be prevented; ten fewer @entity1 would require additional uterotonics; and six fewer @entity1 a blood transfusion. An additional 217 @entity1 would experience shivering and 70 fever. The cost savings would be US 533. Sensitivity analyses indicate that the results are sensitive to the incidence of PPH-related outcomes, drug costs and the proportion of hospital births. CONCLUSIONS: Our findings confirm that, even though @entity396 is not the optimum choice in the prevention of PPH, @entity396 could be an effective and cost-saving choice where @entity398 is not or cannot be used due to a lack of skilled birth attendants, inadequate transport and storage facilities or where a quality assured @entity398 product is not available. These benefits need to be weighed against the large number of additional side effects such as shivering and fever, which have been described as tolerable and of short duration.
