Cost-effectiveness of Carbetocin versus Oxytocin for Prevention of Postpartum Hemorrhage Resulting from Uterine Atony in Women at high-risk for bleeding in Colombia

• Published in: Revista Brasileira de ginecologia e obstetrícia Vol. 40; no. 5; pp. 242 - 250
• Main Authors: Gil-Rojas, Yaneth, Lasalvia, Pieralessandro, Hernández, Fabián, Castañeda-Cardona, Camilo, Rosselli, Diego
• Format: Journal Article
• Language: English
• Published: Rio de Janeiro, Brazil Thieme Revinter Publicações Ltda 01.05.2018; Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
• Subjects: carbetocin; Colombia; Cost-Benefit Analysis; cost-effectiveness; Decision Support Techniques; Female; high-risk; Humans; OBSTETRICS & GYNECOLOGY; Original; Original Article; Oxytocics - economics; Oxytocics - therapeutic use; oxytocin; Oxytocin - analogs & derivatives; Oxytocin - economics; Oxytocin - therapeutic use; Postpartum Hemorrhage - epidemiology; Postpartum Hemorrhage - etiology; Postpartum Hemorrhage - prevention & control; Pregnancy; prevention postpartum hemorrhage; Risk Assessment; Uterine Inertia; Colombia; oxitocina; cost-effectiveness; oxytocin; prevention postpartum hemorrhage; pregnancy; gravidez de alto risco; carbetocina; hemorragia pós-parto; carbetocin; high-risk; prevenção; análise custo-eficiência; análise custoeficiência
• ISSN: 0100-7203; 1806-9339; 1806-9339
• DOI: 10.1055/s-0038-1655747

Abstract Objective  To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/cesarean section in women with risk factors for bleeding. Methods  A decision tree was developed for vaginal delivery and another one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only direct medical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year time horizon. The costs were expressed in 2016 Colombian pesos (1 USD = 3,051 Col$). Results  In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin, while the QALYs were 0.9980 and 0.9979, respectively. The incremental cost-effectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. Conclusion  In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.