Cost-effectiveness results comparing heat-stable carbetocin & other uterotonics in postpartum heamorrhage prevention in Uganda
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Date
2025-04
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Public Library of Science
Abstract
In Uganda, postpartum haemorrhage (PPH) is responsible for 34% of all institutional maternal deaths. Injectable oxytocin is the preferred uterotonic for prevention of PPH. However, in resource-limited settings, the effectiveness of oxytocin is sub-optimal due to efficacy, quality (cold chain storage requirements), and manufacturing standards (poor quality active pharmaceutical ingredients, lack of sterile manufacturing environment, and low-quality manufacturing processes). This study aimed to assess the cost-effectiveness of heat-stable carbetocin, a quality uterotonic newly recommended by WHO and Ugandan Ministry of Health, compared to standard uterotonics for the prevention of PPH in Uganda. A decision tree model was built to assess the cost-effectiveness of heat-stable carbetocin compared to the current standards of care – oxytocin, misoprostol or oxytocoin+misoprostol combination. The model was applied to a hypothetical annual cohort of birthing women eligible for PPH prevention in Uganda’s public health facilities. The evaluation considered direct costs and health outcomes using a public health perspective. The model inputs were obtained through literature review and, whenever referencable information was unavailable or incomplete, from key opinion leaders. Compared to oxytocin, administering heat-stable carbetocin to prevent PPH had a cascading favorable effect and was estimated to avert 57,536 PPH cases, 123 maternal deaths, and 4,203 disability-adjusted life years (DALYs). Heat-stable carbetocin is also cost-saving where the direct cost to the public healthcare system was lower by USD $1,058,353 (UGX 3,998,350,875). The benefits of heat-stable carbetocin were even greater when compared with misoprostol (averted 73,939 PPH events, 273 maternal deaths, and 8,716 DALYs, and lowered public healthcare system costs by USD $2,118,372 [UGX 8,002,996,052]). Heat-stable carbetocin for preventing PPH in Uganda has the potential to reduce PPH events, and subsequently maternal deaths, DALYs, and costs for the public healthcare system. Adopting heat-stable carbetocin will contribute towards achieving the country’s Sustainable Development Goal 3.1.
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Ononge, Sam, Othman Kakaire, Jostas Mwembezi, et al. 'Cost-Effectiveness Results Comparing Heat-Stable Carbetocin & Other Uterotonics in Postpartum Heamorrhage Prevention in Uganda', PLOS Global Public Health, vol. 5/no. 4, (2025), .