title: Community-based distribution of misoprostol for treatment or prevention of postpartum hemorrhage: cost-effectiveness, mortality, and morbidity reduction analysis.
abstract: OBJECTIVE
  To compare the cost-effectiveness of community-based distribution of misoprostol for prevention with misoprostol for treatment of postpartum hemorrhage (PPH).
  
  
  METHODS
  A Monte Carlo simulation depicted mortality and anemia-related morbidity attributable to PPH among 3 scenarios of 10,000 women delivering at home in rural India: (1) standard management; (2) standard management plus 800microg of sublingual misoprostol for PPH treatment; and (3) standard management plus 600microg of prophylactic oral misoprostol. The model included costs of drugs, birth attendant training, and transport for women who did not respond to misoprostol.
  
  
  RESULTS
  Misoprostol lowered mortality by 70% and 81% in scenarios 2 and 3, respectively. Scenarios 2 and 3 raise costs by 6% and 35%, respectively. Incremental cost per disability-adjusted life year (DALY) saved is estimated at $6 and $170, respectively.
  
  
  CONCLUSIONS
  Both interventions were more effective at decreasing mortality and anemia than standard management. The most efficient scale-up plan would focus initially on increasing coverage with the treatment strategy ($6 per DALY).
authors.affiliation: Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, USA. Tori.Sutherland@utsouthwestern.edu
authors.forename: Tori
authors.initials: T
authors.lastname: Sutherland
authors.forename: Carinne
authors.initials: C
authors.lastname: Meyer
authors.forename: David M
authors.initials: DM
authors.lastname: Bishai
authors.forename: Stacie
authors.initials: S
authors.lastname: Geller
authors.forename: Suellen
authors.initials: S
authors.lastname: Miller
mesh_terms: D003150:Community Health Workers; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D005260:Female; D006700:Home Childbirth; D006801:Humans; D007194:India / Q000453:epidemiology; D016595:Misoprostol / Q000191:economics / Q000627:therapeutic use*; D018803:Models, Economic; D009010:Monte Carlo Method; D010120:Oxytocics / Q000191:economics / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D011247:Pregnancy
chemical_list: D010120:Oxytocics; D016595:Misoprostol