University of Texas Southwestern Medical Center, Dallas, Texas, United States of America.
PLoS One. 2013 Apr 30;8(4):e62282. doi: 10.1371/journal.pone.0062282. Print 2013.
To assess the cost-effectiveness of a non-pneumatic anti-shock garment (NASG) for obstetric hemorrhage in tertiary hospitals in Egypt and Nigeria.
We combined published data from pre-intervention/NASG-intervention clinical trials with costs from study sites. For each country, we used observed proportions of initial shock level (mild: mean arterial pressure [MAP] >60 mmHg; severe: MAP ≤60 mmHg) to define a standard population of 1,000 women presenting in shock. We examined three intervention scenarios: no women in shock receive the NASG, only women in severe shock receive the NASG, and all women in shock receive the NASG. Clinical data included frequencies of adverse health outcomes (mortality, severe morbidity, severe anemia), and interventions to manage bleeding (uterotonics, blood transfusions, hysterectomies). Costs (in 2010 international dollars) included the NASG, training, and clinical interventions. We compared costs and disability-adjusted life years (DALYs) across the intervention scenarios.
For 1000 women presenting in shock, providing the NASG to those in severe shock results in decreased mortality and morbidity, which averts 357 DALYs in Egypt and 2,063 DALYs in Nigeria. Differences in use of interventions result in net savings of $9,489 in Egypt (primarily due to reduced transfusions) and net costs of $6,460 in Nigeria, with a cost per DALY averted of $3.13. Results of providing the NASG for women in mild shock has smaller and uncertain effects due to few clinical events in this data set.
Using the NASG for women in severe shock resulted in markedly improved health outcomes (2-2.9 DALYs averted per woman, primarily due to reduced mortality), with net savings or extremely low cost per DALY averted. This suggests that in resource-limited settings, the NASG is a very cost-effective intervention for women in severe hypovolemic shock. The effects of the NASG for mild shock are less certain.
评估在埃及和尼日利亚的三级医院中使用非充气式抗休克服（NASG）治疗产科出血的成本效益。
我们结合了干预前/NASG 干预临床试验的数据和研究地点的成本。对于每个国家，我们使用观察到的初始休克水平比例（轻度：平均动脉压 [MAP] >60mmHg；重度：MAP ≤60mmHg）来定义一个标准的 1000 名休克女性人群。我们检查了三种干预方案：没有休克的女性使用 NASG，只有重度休克的女性使用 NASG，所有休克的女性使用 NASG。临床数据包括不良健康结局（死亡率、严重发病率、严重贫血）的频率，以及用于管理出血的干预措施（宫缩剂、输血、子宫切除术）。成本（2010 年国际美元）包括 NASG、培训和临床干预。我们比较了干预方案之间的成本和残疾调整生命年（DALY）。
对于 1000 名出现休克的女性，为重度休克的女性提供 NASG 可降低死亡率和发病率，在埃及可避免 357 个 DALY，在尼日利亚可避免 2063 个 DALY。干预措施的使用差异导致埃及净节省 9489 美元（主要是由于输血减少），尼日利亚净成本 6460 美元，每避免一个 DALY 的成本为 3.13 美元。由于在这个数据集，轻度休克的女性发生的临床事件较少，因此提供 NASG 的效果较小且不确定。
对重度休克的女性使用 NASG 可显著改善健康结局（每例女性避免 2-2.9 个 DALY，主要是由于死亡率降低），并节省净成本或避免每 DALY 的极低成本。这表明，在资源有限的情况下，NASG 是治疗严重低血容量性休克女性的一种非常具有成本效益的干预措施。NASG 对轻度休克的影响不太确定。
