Centre for Health Policy & Global Burden of Disease Group, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia.
Agency for Clinical Innovation, NSW Ministry of Health, Sydney, NSW, 2067, Australia.
BMC Med. 2020 Jul 28;18(1):201. doi: 10.1186/s12916-020-01658-y.
Access to oxytocin for prevention of postpartum haemorrhage (PPH) in resource-poor settings is limited by the requirement for a consistent cold chain and for a skilled attendant to administer the injection. To overcome these barriers, heat-stable, non-injectable formulations of oxytocin are under development, including oxytocin for inhalation. This study modelled the cost-effectiveness of an inhaled oxytocin product (IHO) in Bangladesh and Ethiopia.
A decision analytic model was developed to assess the cost-effectiveness of IHO for the prevention of PPH compared to the standard of care in Bangladesh and Ethiopia. In Bangladesh, introduction of IHO was modelled in all public facilities and home deliveries with or without a skilled attendant. In Ethiopia, IHO was modelled in all public facilities and home deliveries with health extension workers. Costs (costs of introduction, PPH prevention and PPH treatment) and effects (PPH cases averted, deaths averted) were modelled over a 12-month program. Life years gained were modelled over a lifetime horizon (discounted at 3%). Cost of maintaining the cold chain or effects of compromised oxytocin quality (in the absence of a cold chain) were not modelled.
In Bangladesh, IHO was estimated to avert 18,644 cases of PPH, 76 maternal deaths and 1954 maternal life years lost. This also yielded a cost-saving, with the majority of gains occurring among home deliveries where IHO would replace misoprostol. In Ethiopia, IHO averted 3111 PPH cases, 30 maternal deaths and 767 maternal life years lost. The full IHO introduction program bears an incremental cost-effectiveness ratio (ICER) of between 2 and 3 times the per-capita Gross Domestic Product (GDP) ($1880 USD per maternal life year lost) and thus is unlikely to be considered cost-effective in Ethiopia. However, the ICER of routine IHO administration considering recurring cost alone falls under 25% of per-capita GDP ($175 USD per maternal life-year saved).
IHO has the potential to expand access to uterotonics and reduce PPH-associated morbidity and mortality in high burden settings. This can facilitate reduced spending on PPH management, making the product highly cost-effective in settings where coverage of institutional delivery is lagging.
在资源匮乏的环境中，催产素用于预防产后出血（PPH）的供应受到冷链要求和熟练助产士注射的限制。为了克服这些障碍，正在开发热稳定、非注射型的催产素制剂，包括催产素吸入剂。本研究旨在对孟加拉国和埃塞俄比亚使用催产素吸入制剂（IHO）预防 PPH 的成本效益进行建模。
开发了一种决策分析模型，以评估与孟加拉国和埃塞俄比亚的标准护理相比，IHO 预防 PPH 的成本效益。在孟加拉国，对所有公共设施和有无熟练助产士的家庭分娩中引入 IHO 进行了建模。在埃塞俄比亚，对所有公共设施和有卫生推广人员的家庭分娩中引入 IHO 进行了建模。在 12 个月的项目中，对成本（引入成本、预防 PPH 成本和 PPH 治疗成本）和效果（预防的 PPH 病例数、预防的死亡人数）进行了建模。在终生（折现率为 3%）进行了生命年的获益建模。没有对冷链的维护成本或催产素质量受损的影响（没有冷链的情况下）进行建模。
在孟加拉国，IHO 估计可以预防 18644 例 PPH、76 例产妇死亡和 1954 例产妇生命年损失。这也带来了成本节约，大部分收益发生在家庭分娩中，在这些分娩中，IHO 将取代米索前列醇。在埃塞俄比亚，IHO 预防了 3111 例 PPH、30 例产妇死亡和 767 例产妇生命年损失。全面引入 IHO 方案的增量成本效益比（ICER）为每例丧失的产妇生命年丧失 2 至 3 倍国内生产总值（GDP）（1880 美元/例产妇生命年丧失），因此在埃塞俄比亚不太可能被认为具有成本效益。然而，仅考虑经常性成本的常规 IHO 管理的 ICER 低于人均 GDP 的 25%（175 美元/例产妇生命年的节省）。
IHO 有可能扩大宫缩剂的使用范围，减少高负担地区与 PPH 相关的发病率和死亡率。这可以减少 PPH 管理方面的支出，使该产品在机构分娩覆盖率滞后的地区具有很高的成本效益。
