Economic analysis of interventions for reducing postpartum hemorrhage

October 3, 2006
Research Team
Principal Investigators:
Technical Committee Members:
Country Investigators:
October 3, 2006
Objectives of the Presentation
1) What are the cost-effectiveness ratios of PPH 2) What are the benefit-cost ratios of PPH interventions? 3) What information should we considered in choosing PPH 4) What are the recommended interventions? October 3, 2006
Methods: Types of Interventions Included
October 3, 2006
Methods: Types of Analysis
• Country studies: economic and policy analysis in four • Global analysis (developing countries): economic assessment (the focus of this presentation) October 3, 2006
Methods: Cost
• Incremental cost: additional cost added to the existing system for
• Costs included:
– Logistic costs (wastage, storage and transportation) • Costs excluded:
– Capital cost (building, equipment, vehicle) – Cost of side-effects (for both suffer and treatments) October 3, 2006
Methods: Effectiveness and Benefit
• Effectiveness
• Benefit
– Prevention: treatment cost averted + productivity loss – Benefit excluded: suffer averted, and averted negative consequences to family members and relatives October 3, 2006
Methods: Data and Assumptions
• Distribution of birth delivery by location • Rate of protection against PPH morbidity and morbidity • Availability and best possible coverage of intervention • Wastage, transportation and storage costs October 3, 2006
Methods: Data Analysis
• Spreadsheet-based tool (Economic Assessment of Post
Partum Hemorrhage Interventions (EAPPH))
• The tool consists of three modules: inputs, calculation, • Results are reported in 18 tables, which are categorized – PART I: Effectiveness of PPH Interventions– PART II: Cost Associated with PPH Interventions– PART III: Cost-Effectiveness of PPH Interventions– PART IV: Benefits of Interventions– PART V: Cost-Benefits of Interventions October 3, 2006
Results: Preventive Interventions
Table 1. Cost-effectiveness and cost-benefit analysis of preventive interventions
Total benefit Total cost of Cost per Benefit/C Ranking
intervention
ost ratio
averted intervention
averted ($)
October 3, 2006
Results: Curative Interventions
Table 2. Cost-effectiveness and cost-benefit analysis of curative interventions
Total benefit Total cost of Cost per Benefit/C Ranking
intervention
ost ratio
intervention
averted ($)
October 3, 2006
Results: Sensitivity Analysis
Figure 1. Cost per DALY of preventive interventions with protection rate
+/- 5% points of the point estimate
r DA
e 30
$ p
Oxytocin (Uniject)
Oxytocin
Oxytocin
Syntometrine
Ergometrine
Misoprostol (oral)
Misoprostol
(monodose)
(multidosel)
(rectal)
Interventions
October 3, 2006
Results: Choosing preventive Interventions
Table 3. Choosing preventive PPH interventions
Efficiency
Exclusiveness
Total health
outcomes
October 3, 2006
Results: Choosing Curative Interventions
Table 4. Choosing preventive PPH interventions
Efficiency
Exclusiveness
Total health
outcomes
October 3, 2006
Choosing interventions: Oxy or Miso or Both?
Figure 2. The number of PPH case prevented of different
interventions (per year)
. o
f cases (
Oxytocin
Misoprostol
Oxy+Miso
October 3, 2006
3. The health benefit of combined use of oxytocin
and misoprostol
Misoprostol
Health Benefit
Oxytocin
October 3, 2006
Recommendations
• For prevention of PPH
– Misprostol should be provided where oxytocin is not • For treatment of PPH:
– Syntometrine/oxytocin monodose (IV drip) or oxytocin in – Misprostol (either oral or rectal) is recommended for settings where injectable uterotonics are not available – Other uterotonics can be considered as 2nd line drugs – Balloon temponade and anti-shock garment should be October 3, 2006
Thank You
October 3, 2006

Source: http://www.abtassoc.net/presentations/EconPostpartumHemor.pdf