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A systematic review of the cost‐effectiveness of uterotonic agents for the prevention of postpartum hemorrhage

Lawrie, TA; Rogozińska, E; Sobiesuo, P; Vogel, JP; Ternent, L; Oladapo, OT; (2019) A systematic review of the cost‐effectiveness of uterotonic agents for the prevention of postpartum hemorrhage. International Journal of Gynecology & Obstetrics , 146 (1) pp. 56-64. 10.1002/ijgo.12836. Green open access

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Abstract

BACKGROUND: Several uterotonic options exist for prevention of postpartum hemorrhage (PPH); hence, cost-effectiveness is an important decision-making criterion affecting uterotonic choice. OBJECTIVE: To conduct a systematic review of cost-effectiveness of uterotonics for PPH prevention to support a WHO guideline update. SEARCH STRATEGY: We searched major databases from 1980 to June 2018 and the National Health Services Economic Evaluation (NHS EED) database from inception (1995) to March 2015 for eligible studies. SELECTION CRITERIA: We included comparative economic evaluations, cost-utility analyses, and resource-utilization studies. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies and extracted data organized by birth mode and setting. MAIN RESULTS: We included 15 studies across all income categories that compared misoprostol versus no uterotonic (five studies) or versus oxytocin (one study), carbetocin versus oxytocin (eight studies), and one study comparing numerous uterotonics. In specific low-resource contexts, we found reasonably good evidence that misoprostol was cost-effective compared with no uterotonic. In the context of cesarean delivery, carbetocin was more cost favorable than oxytocin but certainty of this evidence was low. CONCLUSIONS: Evidence on the cost-effectiveness of various uterotonic agents was not generalizable. As the number of competing uterotonics increases, rigorous economic evaluations including contextual factors are needed.

Type: Article
Title: A systematic review of the cost‐effectiveness of uterotonic agents for the prevention of postpartum hemorrhage
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/ijgo.12836
Publisher version: https://doi.org/10.1002/ijgo.12836
Language: English
Additional information: © 2019 World Health Organization, licensed by International Federation of Gynecology and Obstetrics. This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (https://creativecommons.org/licenses/by/3.0/igo/legalcode).
Keywords: Carbetocin, Cost-effectiveness, Ergometrine, Misoprostol, Oxytocin, Postpartum hemorrhage, Prostaglandins, Uterotonics
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10075489
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