Dale Megan, Bell Sarah F, O'Connell Susan, Scarr Cerys, James Kathryn, John Miriam, Collis Rachel E, Collins Peter W, Carolan-Rees Grace
Cedar, Cardiff & Vale University Health Board, Cardiff, UK.
Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK.
Pharmacoecon Open. 2022 Nov;6(6):847-857. doi: 10.1007/s41669-022-00362-2. Epub 2022 Sep 6.
A postpartum haemorrhage quality improvement initiative (the Obstetric Bleeding Strategy for Wales [OBS Cymru]), including about 60,000 maternities, was adopted across Wales (2017-2018). We performed a cost-consequences analysis to inform ongoing provision and wider uptake.
Analysis was based on primary data from the All Wales postpartum haemorrhage database, with a UK National Health Services perspective, a time horizon from delivery until hospital discharge and no discounting. Costs were based on UK published sources with viscoelastic haemostatic assay costs provided by the OBS Cymru national team. Mean costs per eligible patient (postpartum haemorrhage > 1000 mL) were calculated for OBS Cymru, using the early implementation period as a comparator. Modelling allowed comparisons of three scenarios (two predefined and one post hoc) and implementation in different sizes of maternity unit.
All analyses demonstrated consistent savings in blood products, critical care and haematology time, and also a reduced occurrence of massive postpartum haemorrhage (> 2500 mL). Incremental postnatal length of stay varied between scenarios, substantially impacting on total costs. Mean incremental cost of OBS Cymru, compared with standard care, across Wales was £18.41 per patient (postpartum haemorrhage > 1000 mL) or - £10.66 if the length of stay was excluded. Modelling a maternity unit of 5000 births per annum, OBS Cymru incurred an incremental cost of £9.53 per patient with postpartum haemorrhage > 1000 mL.
OBS Cymru reduces the occurrence of massive postpartum haemorrhage, need for transfusions, quantity of blood products and intensive care. In medium-to-large maternity units (>3000 maternities per annum), the OBS Cymru intervention approaches cost neutrality compared to standard care.
威尔士实施了一项产后出血质量改进计划（威尔士产科出血策略[OBS Cymru]），该计划涵盖了约60000例产妇（2017 - 2018年）。我们进行了成本 - 后果分析，以为持续的供应和更广泛的采用提供信息。
分析基于全威尔士产后出血数据库的原始数据，采用英国国家医疗服务体系的视角，时间范围从分娩至出院且不进行贴现。成本基于英国已发表的资料，黏弹性止血检测成本由OBS Cymru国家队提供。以早期实施阶段作为对照，计算了OBS Cymru每例符合条件患者（产后出血>1000 mL）的平均成本。通过建模可以比较三种方案（两种预定义方案和一种事后方案）以及在不同规模产科单位的实施情况。
所有分析均表明，在血液制品、重症监护和血液学检查时间方面持续节省，且大量产后出血（>2500 mL）的发生率降低。各方案之间产后住院时间增量有所不同，对总成本有重大影响。与标准护理相比，威尔士OBS Cymru的平均增量成本为每位患者18.41英镑（产后出血>1000 mL），若排除住院时间，则为 - 10.66英镑。对每年有5000例分娩的产科单位进行建模，产后出血>1000 mL的患者中，OBS Cymru的增量成本为每位患者9.53英镑。
OBS Cymru可减少大量产后出血的发生、输血需求、血液制品用量及重症监护需求。在中型至大型产科单位（每年>3000例产妇）中，与标准护理相比，OBS Cymru干预接近成本中性。
