Carbetocin versus oxytocin for prevention of post-partum haemorrhage at caesarean section in the United Kingdom: An economic impact analysis

Nelson, Helen A Van Der; Siassakos, Dimitrios; Yau, Christopher; Hatswell, Anthony J.

doi:10.1016/j.ejogrb.2017.01.004

Cited by 33 publications

(28 citation statements)

References 20 publications

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“…In a simulated model of 1500 caesarean sections over a 12-month period, using clinical data from a meta-analysis and pricing data from the UK, carbetocin was found to have a 91.5% probability of being associated with a lower incidence of postpartum haemorrhage (reducing cases with blood loss > 500 ml from 88% to 58%) and savings of > £27,000 compared with oxytocin [78]. A similar study from Malaysia found an even higher clinical impact of carbetocin, with a prevention of 54 cases of postpartum haemorrhage and 52 transfusions per 1500 caesarean sections annually, when compared with oxytocin [79].…”

Section: Carbetocinmentioning

confidence: 99%

International consensus statement on the use of uterotonic agents during caesarean section

et al. 2019

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Summary It is routine to give a uterotonic drug following delivery of the neonate during caesarean section. However, there is much heterogeneity in the relevant research, which has largely been performed in low‐risk elective cases or women with uncomplicated labour. This is reflected in considerable variation in clinical practice. There are significant differences between dose requirements during elective and intrapartum caesarean section. Standard recommended doses are higher than required, with the potential for acute cardiovascular adverse effects. We recommend a small initial bolus dose of oxytocin, followed by a titrated infusion. The recommended doses of oxytocin may have to be increased in women with risk factors for uterine atony. Carbetocin at equipotent doses to oxytocin has similar actions, while avoiding the requirement for a continuous infusion after the initial dose and reducing the need for additional uterotonics. As with oxytocin, carbetocin dose requirements are higher for intrapartum caesarean sections. A second‐line agent should be considered early if oxytocin/carbetocin fails to produce good uterine tone. Women with cardiac disease may be very sensitive to the adverse effects of oxytocin and other uterotonics, and their management needs to be individualised.

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Section: Carbetocinmentioning

confidence: 99%

International consensus statement on the use of uterotonic agents during caesarean section

et al. 2019

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“…14 Peru, 20 Senegal, 21 Tanzania, 22 Uganda, 23 and the UK. [24][25][26][27] One of the studies was an international study with a hypothetical cohort. 28 Eleven of these studies were conducted from 2011 to 2018 and four studies were conducted from 2007 to 2010.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…28 Eleven of these studies were conducted from 2011 to 2018 and four studies were conducted from 2007 to 2010. 14,17,18,22 Out of the 15 studies, three studies were funded by pharmaceutical companies, 16,20,27 Institute for Health Research, and others, 17,18,21,22,24,28 three studies were not funded, 23,25,26 in two studies (abstracts) it was unclear whether they were funded or not, 14,15 and one study did not disclose funding sources. 19 The relevant healthcare perspective was used in all studies except in one study, which adopted a WHO perspective.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…17,18,[21][22][23]28 A further eight studies evaluated the cost-effectiveness of carbetocin versus oxytocin across various facility settings. [14][15][16]19,20,[24][25][26]…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Eight cost-effectiveness analyses and one service evaluation study contributed data. [14][15][16]19,20,[24][25][26][27] Four were from a high-income country (UK) and five were from middle-income countries (Columbia, Ecuador, Malaysia, Mexico, and Peru). Apart from the UK-based study that evaluated several uterotonic options, 24 all studies compared carbetocin (100 μg) to oxytocin (5 or 10 IU, if dose was reported).…”

Section: Which Uterotonic Agents Are Cost-effective For Preventing mentioning

confidence: 99%

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

Lawrie

Rogozińska

Sobiesuo

et al. 2019

Intl J Gynecology & Obste

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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.

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FIGO recommendations on the management of postpartum hemorrhage 2022

Escobar

Nassar

Theron

et al. 2022

Intl J Gynecology & Obste

165

114

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Carbetocin versus oxytocin for prevention of post-partum haemorrhage at caesarean section in the United Kingdom: An economic impact analysis

Abstract: At list price, the introduction of carbetocin appears to provide improved clinical outcomes along with cost savings, though this is subject to uncertainty regarding the underlying data in efficacy, resource use, and cost.

Cited by 33 publications

References 20 publications

International consensus statement on the use of uterotonic agents during caesarean section

International consensus statement on the use of uterotonic agents during caesarean section

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

FIGO recommendations on the management of postpartum hemorrhage 2022

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