Abstract：
BACKGROUND: Low- and middle-income countries (LMICs) are committed to achieving the Sustainable Development Goal 3.1 to reduce maternal mortality. The Ministry of Health and Family Welfare of India recommends prophylactic uterotonic administration to every woman following delivery to reduce the risk of postpartum hemorrhage (PPH), as PPH is the leading cause of maternal mortality in LMICs, including India. In 2018, the World Health Organization first recognized heat-stable carbetocin for PPH prevention. Governments are now considering its introduction into their public health systems.
METHODS: A decision-tree model was developed from the public healthcare system perspective to compare the value of heat-stable carbetocin versus oxytocin and misoprostol among women giving birth in public sector healthcare facilities in India. The model accounted for differences in PPH risk and costs based on mode of delivery and healthcare setting, as well as provider behavior to mitigate quality concerns of oxytocin. Model outcomes for each prophylactic uterotonic included the number of PPH events, DALYs due to PPH, deaths due to PPH, and direct medical care costs. The budget impact was estimated based on projected uterotonic uptake between 2022-2026.
RESULTS: Compared to oxytocin, heat-stable carbetocin avoided 5,468 additional PPH events, 5 deaths, and 244 DALYs per 100,000 births. Projected direct medical costs to the public healthcare system were lowered by US $171,700 (₹12.8 million; exchange rate of ₹74.65 = US$1 from 2 Feb 2022) per 100,000 births. Benefits were even greater when compared to misoprostol (7,032 fewer PPH events, 10 fewer deaths, 470 fewer DALYs, and $230,248 saved per 100,000 births). In the budget impact analysis, India\'s public health system is projected to save US$11.4 million (₹849 million) over the next five years if the market share for heat-stable carbetocin grows to 19% of prophylactic uterotonics administered.
CONCLUSIONS: Heat-stable carbetocin is expected to reduce the number of PPH events and deaths, avoid more DALYs, and reduce costs to the public healthcare system of India. Greater adoption of heat-stable carbetocin for the prevention of PPH could advance India\'s efforts to achieve its maternal health goals and increase efficiency of its public health spending.
METHODS: A decision-tree model was developed from the public healthcare system perspective to compare the value of heat-stable carbetocin versus oxytocin and misoprostol among women giving birth in public sector healthcare facilities in India. The model accounted for differences in PPH risk and costs based on mode of delivery and healthcare setting, as well as provider behavior to mitigate quality concerns of oxytocin. Model outcomes for each prophylactic uterotonic included the number of PPH events, DALYs due to PPH, deaths due to PPH, and direct medical care costs. The budget impact was estimated based on projected uterotonic uptake between 2022-2026.
RESULTS: Compared to oxytocin, heat-stable carbetocin avoided 5,468 additional PPH events, 5 deaths, and 244 DALYs per 100,000 births. Projected direct medical costs to the public healthcare system were lowered by US $171,700 (₹12.8 million; exchange rate of ₹74.65 = US$1 from 2 Feb 2022) per 100,000 births. Benefits were even greater when compared to misoprostol (7,032 fewer PPH events, 10 fewer deaths, 470 fewer DALYs, and $230,248 saved per 100,000 births). In the budget impact analysis, India\'s public health system is projected to save US$11.4 million (₹849 million) over the next five years if the market share for heat-stable carbetocin grows to 19% of prophylactic uterotonics administered.
CONCLUSIONS: Heat-stable carbetocin is expected to reduce the number of PPH events and deaths, avoid more DALYs, and reduce costs to the public healthcare system of India. Greater adoption of heat-stable carbetocin for the prevention of PPH could advance India\'s efforts to achieve its maternal health goals and increase efficiency of its public health spending.
摘要：
背景：中低收入国家（LMICs）致力于实现可持续发展目标3.1，以降低孕产妇死亡率。印度卫生和家庭福利部建议在分娩后对每位妇女进行预防性子宫收缩给药，以降低产后出血（PPH）的风险。由于PPH是LMIC孕产妇死亡的主要原因，包括印度。2018年，世界卫生组织首次认可热稳定卡贝缩宫素用于预防PPH。各国政府现在正在考虑将其引入其公共卫生系统。
方法：从公共医疗保健系统的角度开发了决策树模型，以比较热稳定的卡贝缩宫素与催产素和米索前列醇在印度公共部门医疗机构分娩的妇女中的价值。该模型根据交付方式和医疗保健环境考虑了PPH风险和成本的差异，以及提供者减轻催产素质量问题的行为。每种预防性子宫收缩的模型结果包括PPH事件的数量，由于PPH导致的DALYs，PPH导致的死亡，和直接医疗费用。预算影响是根据2022年至2026年之间的子宫内膜吸收估计的。
结果：与催产素相比，热稳定的卡贝缩宫素避免了5,468个额外的PPH事件，5人死亡,和每100,000个出生244个残疾调整年。预计公共医疗系统的直接医疗费用降低了每100,000名新生儿171,700美元（1280万卢比；从2022年2月2日起，汇率为74.65卢比=1美元）。与米索前列醇相比，益处甚至更大(PPH事件减少7,032，死亡人数减少10人,减少470个DALYs，和每100,000个出生节省230,248美元)。在预算影响分析中，如果热稳定的卡贝缩宫素的市场份额增长到预防性子宫收缩剂的19％，印度的公共卫生系统预计将在未来五年内节省1140万美元（8.49亿卢比）。
结论：热稳定的卡贝缩宫素有望减少PPH事件和死亡的数量，避免更多DALY，并降低印度公共医疗系统的成本。更多采用热稳定的卡贝缩宫素预防PPH可能会促进印度实现其孕产妇健康目标并提高其公共卫生支出效率的努力。
方法：从公共医疗保健系统的角度开发了决策树模型，以比较热稳定的卡贝缩宫素与催产素和米索前列醇在印度公共部门医疗机构分娩的妇女中的价值。该模型根据交付方式和医疗保健环境考虑了PPH风险和成本的差异，以及提供者减轻催产素质量问题的行为。每种预防性子宫收缩的模型结果包括PPH事件的数量，由于PPH导致的DALYs，PPH导致的死亡，和直接医疗费用。预算影响是根据2022年至2026年之间的子宫内膜吸收估计的。
结果：与催产素相比，热稳定的卡贝缩宫素避免了5,468个额外的PPH事件，5人死亡,和每100,000个出生244个残疾调整年。预计公共医疗系统的直接医疗费用降低了每100,000名新生儿171,700美元（1280万卢比；从2022年2月2日起，汇率为74.65卢比=1美元）。与米索前列醇相比，益处甚至更大(PPH事件减少7,032，死亡人数减少10人,减少470个DALYs，和每100,000个出生节省230,248美元)。在预算影响分析中，如果热稳定的卡贝缩宫素的市场份额增长到预防性子宫收缩剂的19％，印度的公共卫生系统预计将在未来五年内节省1140万美元（8.49亿卢比）。
结论：热稳定的卡贝缩宫素有望减少PPH事件和死亡的数量，避免更多DALY，并降低印度公共医疗系统的成本。更多采用热稳定的卡贝缩宫素预防PPH可能会促进印度实现其孕产妇健康目标并提高其公共卫生支出效率的努力。
