Cost-effectiveness of misoprostol and prenatal iron supplementation as maternal mortality interventions in home births in rural India.
OBJECTIVE
To determine the cost-effectiveness of prenatal iron supplementation and misoprostol use as interventions to prevent maternal mortality in home births in rural India.


METHODS
A cost-effectiveness analysis depicted three hypothetical cohorts of 10,000 pregnant women delivering at home in rural India: one with no intervention, one receiving standard prenatal iron supplements, and 1 receiving 600 microg of misoprostol in the third stage of labor.


RESULTS
Misoprostol used to prevent postpartum hemorrhage resulted in a 38% (95% CI, 5%-73%) decrease in maternal deaths, while prenatal iron supplementation resulted in a 5% (95% CI, 0%-47%) decrease. Misoprostol cost a median US $1401 (IQR US $1008-$1848) prenatal iron supplementation cost a median US $2241 (IQR No Lives Saved-$3882) per life saved compared with the standard care outcome.


CONCLUSIONS
Misoprostol is a cost-effective maternal mortality intervention for home births. Iron supplementation may be worthwhile to improve women's health, but it is uncertain whether it can prevent mortality after hemorrhage.
Sutherland
Tori
T
Department of Obstetrics and Gynecology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224-2780, USA. tori.sutherland@gmail.com
Bishai
David M
DM
D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D019587:Dietary Supplements / Q000191:economics*; D005260:Female; D006700:Home Childbirth; D006801:Humans; D007194:India; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage* / Q000627:therapeutic use; D008428:Maternal Mortality; D016595:Misoprostol / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D010120:Oxytocics / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics; D011295:Prenatal Care / Q000191:economics; D019035:Rural Health Services; D012424:Rural Population
D010120:Oxytocics; D016595:Misoprostol; D007501:Iron