Lee Yi-Fang Ashley, Higgins Colleen R, Procter Petra, Rushwan Sara, Gülmezoglu A Metin, Chinery Lester, Ozawa Sachiko
Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA.
Concept Foundation, Geneva, Switzerland.
BMC Pregnancy Childbirth. 2025 Apr 26;25(1):510. doi: 10.1186/s12884-025-07189-9.
Maternal mortality due to postpartum hemorrhage (PPH) remains a global concern especially in low- and lower-middle income countries. PPH is preventable with quality-assured uterotonics. However, substandard uterotonics pose a significant risk to PPH, and there is limited evidence available to provide quantitative estimates of their economic impact. This study aims to evaluate the impact of ensuring uterotonic quality in Senegal, highlighting the potential to lower healthcare costs, reduce maternal deaths, and contribute to achieving Sustainable Development Goals related to maternal health and Universal Healthcare Coverage.
We utilized a decision tree model to estimate the economic and health impact of improving the quality of uterotonics in prevention of PPH in Senegal. We simulated women giving birth in various healthcare settings, receiving uterotonics of varied quality, and subsequent PPH-related outcomes. Data from the Senegal Demographic and Health Survey, Cochrane review, and E-MOTIVE trial informed the model. We compared scenarios with and without substandard uterotonics, along with scenarios altering uterotonic usage and care-seeking behavior.
Our findings indicate that utilizing quality-assured uterotonics in Senegal could lead to a notable 7-9% reduction in the overall economic burden of PPH, saving over 1 million USD annually in direct costs and long-term productivity losses. Improving the quality of uterotonics in Senegal would result in a 6-8% reduction in PPH cases, translating to over 5,000 fewer PPH cases annually. Using quality uterotonics instead of substandard ones also decreased deaths from PPH by 6-8% annually.
This study underscores the importance of ensuring uterotonic quality to showcase significant cost savings and improvements in maternal health outcomes in Senegal. The accrued cost savings from improved maternal health outcomes related to PPH prevention and treatment would greatly benefit mothers, their families, healthcare providers, and the healthcare system. This case study offers valuable insights into improving the quality of maternal care and achieving more efficient resource allocation to advance Senegal's progress towards Universal Health Coverage.
产后出血（PPH）导致的孕产妇死亡仍是一个全球关注的问题，尤其是在低收入和中低收入国家。有质量保证的宫缩剂可预防产后出血。然而，不合格的宫缩剂对产后出血构成重大风险，且现有证据有限，无法对其经济影响进行定量评估。本研究旨在评估在塞内加尔确保宫缩剂质量的影响，突出降低医疗成本、减少孕产妇死亡以及为实现与孕产妇健康和全民健康覆盖相关的可持续发展目标做出贡献的潜力。
我们利用决策树模型来估计提高宫缩剂质量对塞内加尔预防产后出血的经济和健康影响。我们模拟了在不同医疗环境中分娩的妇女，她们接受质量各异的宫缩剂以及随后与产后出血相关的结果。来自塞内加尔人口与健康调查、Cochrane系统评价和E-MOTIVE试验的数据为该模型提供了信息。我们比较了有无不合格宫缩剂的情况，以及改变宫缩剂使用和就医行为的情况。
我们的研究结果表明，在塞内加尔使用有质量保证的宫缩剂可使产后出血的总体经济负担显著降低7%-9%，每年在直接成本和长期生产力损失方面节省超过100万美元。提高塞内加尔宫缩剂的质量将使产后出血病例减少6%-8%，即每年减少超过5000例产后出血病例。使用质量合格的宫缩剂而非不合格的宫缩剂还可使产后出血导致的死亡每年减少6%-8%。
本研究强调了确保宫缩剂质量对于在塞内加尔实现显著成本节约和改善孕产妇健康结果的重要性。与预防和治疗产后出血相关的孕产妇健康结果改善所带来的成本节约将使母亲及其家庭、医疗服务提供者和医疗系统受益匪浅。本案例研究为改善孕产妇护理质量和实现更有效的资源分配提供了宝贵见解，以推动塞内加尔在全民健康覆盖方面取得进展。
