Oxytocin in Uniject Disposable Auto-Disable Injection System versus Standard Use for the Prevention of Postpartum Hemorrhage in Latin America and the Caribbean: A CostEffectiveness Analysis

PICHON-RIVIERE A,; GLUJOVSKY D,; GARAY OU,; AUGUSTOVSKI F,; CIAPPONI A,; SERPA M,; ALTHABE F.

PLOS ONE

PUBLIC LIBRARY SCIENCE

Lugar: San Francisco; Año: 2015

1932-6203

Postpartum hemorrhage (PPH) is a leading cause of maternal death. Despite strong evidenceshowing the efficacy of routine oxytocin in preventing PPH, the proportion of womenreceiving it after delivery is still below 100%. The Uniject injection system prefilled with oxytocin(Uniject) has the potential advantage, due to its ease of use, to increase oxytocin utilizationrates. We aimed to assess its cost-effectiveness in Latin America and the Caribbean(LAC). We used an epidemiological model to estimate: a) the impact of replacing oxytocin inampoules with Uniject on the incidence of PPH, quality-adjusted life years (QALYs) andcosts from a health care system perspective, and b) the minimum increment in oxytocin utilizationrates required to make Uniject a cost-effective strategy. A consensus panel of LACexperts was convened to quantify the expected increase in oxytocin rates as a consequenceof making Uniject available. Deterministic and probabilistic sensitivity analyseswere performed. In the base case, the incremental cost of Uniject with respect to oxytocin inampoules was estimated to be USD 1.00 (2013 US dollars). In the cost-effectiveness analysis,Uniject ranged from being cost-saving (in 8 out of 30 countries) to having an incrementalcost-effectiveness ratio (ICER) of USD 8,990 per QALY gained. In most countries theseICERs were below one GDP per capita. The minimum required increment in oxytocin ratesto make Uniject a cost-effective strategy ranged from 1.3% in Suriname to 16.2% in Haiti.Switching to Uniject could prevent more than 40,000 PPH events annually in LAC. Unijectwas cost-saving or very cost-effective in almost all countries. Even if countries can achieveonly small increases in oxytocin rates by incorporating Uniject, this strategy could be considereda highly efficient use of resources. These results were robust in the sensitivity analysisunder a wide range of assumptions.