Lee Yi-Fang Ashley, Higgins Colleen R, Procter Petra, Rushwan Sara, Anyakora Chimezie, Gülmezoglu Ahmet Metin, Chinery Lester, Ozawa Sachiko
Division of Practice Advancement and Clinical Education, The University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA.
Concept Foundation, Geneva, Switzerland.
BMJ Public Health. 2025 Apr 5;3(1):e000624. doi: 10.1136/bmjph-2023-000624. eCollection 2025 Jan.
Little evidence exists on the economic threat that substandard uterotonics pose to postpartum haemorrhage (PPH), maternal mortality, and national health systems. For clinical emergencies such as PPH, the quality of the uterotonic drugs required for prevention and treatment plays a central role in whether a severe outcome or fatality occurs and has a direct knock-on effect on the cost of further treatment and care. We modelled the health and economic burden of substandard uterotonics on PPH in Nigeria.
A decision-tree model was built to simulate women giving birth in various healthcare settings, using uterotonics of varying quality, and facing PPH risks. We used the Demographic and Health Survey for care-seeking data and the Cochrane review for uterotonic effectiveness. Trial data from the Early detection of postpartum haemorrhage and treatment using the WHO MOTIVE bundle (E-MOTIVE) was applied for health outcomes by oxytocin quality. Scenarios were compared with and without substandard uterotonics.
We estimated that using substandard uterotonics led to avertable out-of-pocket and productivity losses totaling US$89 million (~₦ 68.4 billion) annually in Nigeria. These avertable losses were the result of using substandard uterotonics in 1.6 million mothers. Without substandard uterotonics, healthcare providers can avert nearly 75 000 preventable PPH cases, reduce uterotonic use, save blood transfusions and avert around 1500 maternal deaths due to PPH annually in Nigeria.
This study demonstrates that use of quality-assured uterotonics would result in substantial reductions in the economic and health burden of PPH and contribute to decreasing maternal mortality and morbidity. Use of substandard uterotonics leads to increased out-of-pocket expenses and costs to health systems, which should be prevented to promote universal health coverage (UHC). Medicines quality assurance improves health outcomes and results in cost savings for governments to scale their implementation of UHC.
关于不合格宫缩剂对产后出血（PPH）、孕产妇死亡率和国家卫生系统构成的经济威胁，现有证据很少。对于PPH等临床紧急情况，预防和治疗所需宫缩剂药物的质量对于严重后果或死亡是否发生起着核心作用，并对进一步治疗和护理的成本产生直接连锁反应。我们对尼日利亚不合格宫缩剂对PPH造成的健康和经济负担进行了建模。
构建了一个决策树模型，以模拟在不同医疗环境中分娩、使用不同质量宫缩剂且面临PPH风险的妇女。我们使用人口与健康调查获取就医数据，并使用Cochrane综述获取宫缩剂有效性数据。来自使用世界卫生组织MOTIVE包（E-MOTIVE）进行产后出血早期检测和治疗的试验数据，用于按催产素质量划分的健康结果。对有无不合格宫缩剂的情况进行了比较。
我们估计，在尼日利亚，使用不合格宫缩剂每年导致可避免的自付费用和生产力损失总计8900万美元（约合6840亿奈拉）。这些可避免的损失是160万母亲使用不合格宫缩剂的结果。如果没有不合格宫缩剂，医疗服务提供者每年在尼日利亚可避免近75000例可预防的PPH病例，减少宫缩剂使用，节省输血，并避免约1500例因PPH导致的孕产妇死亡。
本研究表明，使用质量有保证的宫缩剂将大幅降低PPH的经济和健康负担，并有助于降低孕产妇死亡率和发病率。使用不合格宫缩剂会增加自付费用和卫生系统成本，应加以预防以促进全民健康覆盖（UHC）。药品质量保证可改善健康结果，并为政府扩大UHC实施规模节省成本。
