A systematic review of the cost‐effectiveness of uterotonic agents for the prevention of postpartum hemorrhage

摘要

Abstract Background Several uterotonic options exist for prevention of postpartum hemorrhage ( PPH ); hence, cost‐effectiveness is an important decision‐making criterion affecting uterotonic choice. Objective To conduct a systematic review of cost‐effectiveness of uterotonics for PPH prevention to support a WHO guideline update. Search strategy We searched major databases from 1980 to June 2018 and the National Health Services Economic Evaluation ( NHS EED ) database from inception (1995) to March 2015 for eligible studies. Selection criteria We included comparative economic evaluations, cost‐utility analyses, and resource‐utilization studies. Data collection and analysis Two reviewers independently assessed studies and extracted data organized by birth mode and setting. Main results We included 15 studies across all income categories that compared misoprostol versus no uterotonic (five studies) or versus oxytocin (one study), carbetocin versus oxytocin (eight studies), and one study comparing numerous uterotonics. In specific low‐resource contexts, we found reasonably good evidence that misoprostol was cost‐effective compared with no uterotonic. In the context of cesarean delivery, carbetocin was more cost favorable than oxytocin but certainty of this evidence was low. Conclusions Evidence on the cost‐effectiveness of various uterotonic agents was not generalizable. As the number of competing uterotonics increases, rigorous economic evaluations including contextual factors are needed.