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The cost-effectiveness of preventing, diagnosing, and treating postpartum haemorrhage: A systematic review of economic evaluations

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Listed:
  • Joshua F Ginnane
  • Samia Aziz
  • Saima Sultana
  • Connor Luke Allen
  • Annie McDougall
  • Katherine E Eddy
  • Nick Scott
  • Joshua P Vogel

Abstract

Background: Postpartum haemorrhage (PPH) is an obstetric emergency. While PPH-related deaths are relatively rare in high-resource settings, PPH continues to be the leading cause of maternal mortality in limited-resource settings. We undertook a systematic review to identify, assess, and synthesise cost-effectiveness evidence on postpartum interventions to prevent, diagnose, or treat PPH. Methods and findings: This systematic review was prospectively registered on PROSPERO (CRD42023438424). We searched Medline, Embase, NHS Economic Evaluation Database (NHS EED), EconLit, CINAHL, Emcare, Web of Science, and Global Index Medicus between 22 June 2023 and 11 July 2024 with no date or language limitations. Full economic evaluations of any postpartum intervention for prevention, detection, or management of PPH were eligible. Study screening, data extraction, and quality assessments (using the CHEC-E tool) were undertaken independently by at least 2 reviewers. We developed narrative syntheses of available evidence for each intervention. Conclusions: In this systematic review, we extracted, critically appraised, and summarised the cost-effectiveness evidence from 56 studies across 16 different interventions for the prevention, diagnosis, and treatment of PPH. Both the use of tranexamic acid as part of PPH treatment, and the use of comprehensive PPH bundles for prevention, diagnosis, and treatment have supportive cost-effectiveness evidence across a range of settings. More studies utilizing best practice principles are required to make stronger conclusions on which interventions provide the best value. Several high-priority interventions recommended by World Health Organization (WHO) such as administering additional uterotonics, non-pneumatic anti-shock garment, or uterine balloon tamponade (UBT) for PPH management require robust economic evaluations across high-, middle-, and low-resource settings. Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Joshua F Ginnane & Samia Aziz & Saima Sultana & Connor Luke Allen & Annie McDougall & Katherine E Eddy & Nick Scott & Joshua P Vogel, 2024. "The cost-effectiveness of preventing, diagnosing, and treating postpartum haemorrhage: A systematic review of economic evaluations," PLOS Medicine, Public Library of Science, vol. 21(9), pages 1-38, September.
    • Handle: RePEc:plo:pmed00:1004461
    DOI: 10.1371/journal.pmed.1004461
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    References listed on IDEAS

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    1. Karen Pickering & Ioannis D. Gallos & Helen Williams & Malcolm J. Price & Abi Merriel & David Lissauer & Aurelio Tobias & G. Justus Hofmeyr & Arri Coomarasamy & Tracy E. Roberts, 2019. "Uterotonic Drugs for the Prevention of Postpartum Haemorrhage: A Cost-Effectiveness Analysis," PharmacoEconomics - Open, Springer, vol. 3(2), pages 163-176, June.
    2. Juan Jose Diaz & Miguel Jaramillo, 2009. "Evaluating interventions to reduce maternal mortality: evidence from Peru's PARSalud programme," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 1(4), pages 387-412.
    3. Prata, Ndola & Sreenivas, Amita & Greig, Fiona & Walsh, Julia & Potts, Malcolm, 2010. "Setting priorities for safe motherhood interventions in resource-scarce settings," Health Policy, Elsevier, vol. 94(1), pages 1-13, January.
    4. Megan Dale & Sarah F Bell & Susan O’Connell & Cerys Scarr & Kathryn James & Miriam John & Rachel E Collis & Peter W Collins & Grace Carolan-Rees, 2022. "What is the Economic Cost of Providing an All Wales Postpartum Haemorrhage Quality Improvement Initiative (OBS Cymru)? A Cost-Consequences Comparison with Standard Care," PharmacoEconomics - Open, Springer, vol. 6(6), pages 847-857, November.
    5. repec:plo:pmed00:1003001 is not listed on IDEAS
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