Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland.
Evidence-Based Medicine Consultancy Ltd, Bath, UK.
Int J Gynaecol Obstet. 2019 Jul;146(1):56-64. doi: 10.1002/ijgo.12836. Epub 2019 May 20.
Several uterotonic options exist for prevention of postpartum hemorrhage (PPH); hence, cost-effectiveness is an important decision-making criterion affecting uterotonic choice.
To conduct a systematic review of cost-effectiveness of uterotonics for PPH prevention to support a WHO guideline update.
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.
We included comparative economic evaluations, cost-utility analyses, and resource-utilization studies.
Two reviewers independently assessed studies and extracted data organized by birth mode and setting.
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.
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.
有几种缩宫素可供选择用于预防产后出血（PPH）；因此，成本效益是影响缩宫素选择的一个重要决策标准。
对用于预防产后出血的缩宫素的成本效益进行系统评价，以支持世卫组织指南的更新。
我们从 1980 年到 2018 年 6 月检索了主要数据库，并从 1995 年开始到 2015 年 3 月检索了国家卫生服务经济评估（NHS EED）数据库，以检索合格的研究。
我们纳入了比较性经济评估、成本效用分析和资源利用研究。
两名评审员独立评估了研究，并按照分娩方式和环境对数据进行了分类。
我们纳入了来自所有收入类别的 15 项研究，这些研究比较了米索前列醇与无缩宫素（5 项研究）或与催产素（1 项研究）、卡贝缩宫素与催产素（8 项研究），以及一项比较多种缩宫素的研究。在特定的资源匮乏环境中，我们发现米索前列醇相对于无缩宫素具有相当好的成本效益。在剖宫产的情况下，卡贝缩宫素比催产素更具成本效益，但这一证据的确定性较低。
各种缩宫素药物的成本效益证据不具有普遍性。随着竞争缩宫素的数量增加，需要进行包括环境因素在内的严格经济评估。
