Cost-effectiveness and Budget Impact of Introducing Heat-stable Carbetocin for Postpartum Hemorrhage Prevention in Nigeria

Abstract

Background and Objective: Nigeria accounts for about 28.5% of the global maternal death burden, with 22% of these deaths caused by postpartum hemorrhage (PPH). The high prevalence of poor-quality uterotonics, particularly oxytocin and misoprostol, results in more PPH cases. Heat-stable carbetocin (HSC), a thermo-stable analog of oxytocin, is a suitable uterotonic option for preventing PPH, particularly in regions like Nigeria where the quality of oxytocin, the “gold standard uterotonic, ” cannot be assured.

Methods: This evaluation assesses the cost-effectiveness, budget, and health impacts of introducing HSC compared to current prophylactic standards for PPH prevention among women delivering in public healthcare facilities in Nigeria. Quantitative data on direct healthcare system costs of using oxytocin, misoprostol, oxytocin– misoprostol combination, and HSC to prevent PPH collected from one state in each of six geopolitical zones in Nigeria served as inputs into a hierarchical decision-tree model built to generate public healthcare system perspective outputs on related PPH deaths and disabilities (disability-adjusted life-years), budget impact, and cost-effectiveness.

Results: In a cohort of 2,548,136 deliveries, HSC may avert 111,652 PPH events when compared against oxytocin. This includes 12,873 PPH cases, 31,442 severe morbidities (disability-adjusted life years), and 1,165 deaths. These are associated with a 6% reduction in total cost to the health system and cost per woman, respectively. The budget impact analysis revealed a possible total cumulative savings to the public healthcare system of ₦352,798,943 (USD $ 235,199) if HSC is scaled up over 5 years to a 17% market share of prophylactic uterotonics administered.

Conclusion and Global Health Implications: Introducing HSC for PPH prevention may be a cost-effective public health intervention in Nigeria when compared to oxytocin, the current standard of care to prevent PPH. Health-economic modeling projects HSC to be associated with lower costs to the health system while conferring better maternal health outcomes when compared to oxytocin or oxytocin–misoprostol combination.