Cost-effectiveness of prophylactic magnesium sulphate for 9996 women with pre-eclampsia from 33 countries: economic evaluation of the Magpie Trial.
OBJECTIVE
To assess the cost-effectiveness of using magnesium sulphate for pre-eclampsia to prevent eclampsia.


METHODS
Multinational trial-based economic evaluation.


METHODS
Thirty-three countries participating in the Magnesium Sulphate for Prevention of Eclampsia (Magpie) Trial.


METHODS
Women (9996) with pre-eclampsia from the Magpie Trial.


METHODS
Outcome and hospital resource use data were available for the trial period from the Magpie Trial. Country-specific unit costs (U.S. dollar, year 2001) were obtained subsequently from participating hospitals by questionnaire. Cost-effectiveness was estimated for three categories of countries grouped by gross national income (GNI) into high, middle and low GNI countries using a regression model. Uncertainty was explored in sensitivity analyses.


METHODS
Eclampsia, hospital care costs and the incremental cost per case of eclampsia prevented.


RESULTS
The number of women with pre-eclampsia who needed to receive magnesium sulphate to prevent one case of eclampsia was 324 [95% confidence interval (CI) 122, infinity] in high, 184 (95% CI 91, 6798) in middle and 43 (95% CI 30, 68) in low GNI countries. The additional hospital care cost per woman receiving magnesium sulphate was $65, $13 and $11, respectively. The incremental cost of preventing one case of eclampsia was $21,202 in high, $2473 in middle and $456 in low GNI countries. Reserving treatment for severe pre-eclampsia would lower these estimates to $12,942, $1179 and $263.


CONCLUSIONS
Magnesium sulphate for pre-eclampsia costs less and prevents more eclampsia in low GNI than in high GNI countries. Cost-effectiveness substantially improves if it is used only for severe pre-eclampsia, or the purchase price is reduced in low GNI countries.
Simon
Judit
J
Health Economics Research Centre, Department of Public Health, University of Oxford, UK.
Gray
Alastair
A
Duley
Lelia
L
D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D038622:Internationality; D008278:Magnesium Sulfate / Q000191:economics / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000188:drug therapy* / Q000191:economics; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome
D000927:Anticonvulsants; D008278:Magnesium Sulfate