title: Use of the non-pneumatic anti-shock garment (NASG) for life-threatening obstetric hemorrhage: a cost-effectiveness analysis in Egypt and Nigeria.
abstract: OBJECTIVE
  To assess the cost-effectiveness of a non-pneumatic anti-shock garment (NASG) for obstetric hemorrhage in tertiary hospitals in Egypt and Nigeria.
  
  
  METHODS
  We combined published data from pre-intervention/NASG-intervention clinical trials with costs from study sites. For each country, we used observed proportions of initial shock level (mild: mean arterial pressure [MAP] >60 mmHg; severe: MAP ≤60 mmHg) to define a standard population of 1,000 women presenting in shock. We examined three intervention scenarios: no women in shock receive the NASG, only women in severe shock receive the NASG, and all women in shock receive the NASG. Clinical data included frequencies of adverse health outcomes (mortality, severe morbidity, severe anemia), and interventions to manage bleeding (uterotonics, blood transfusions, hysterectomies). Costs (in 2010 international dollars) included the NASG, training, and clinical interventions. We compared costs and disability-adjusted life years (DALYs) across the intervention scenarios.
  
  
  RESULTS
  For 1000 women presenting in shock, providing the NASG to those in severe shock results in decreased mortality and morbidity, which averts 357 DALYs in Egypt and 2,063 DALYs in Nigeria. Differences in use of interventions result in net savings of $9,489 in Egypt (primarily due to reduced transfusions) and net costs of $6,460 in Nigeria, with a cost per DALY averted of $3.13. Results of providing the NASG for women in mild shock has smaller and uncertain effects due to few clinical events in this data set.
  
  
  CONCLUSIONS
  Using the NASG for women in severe shock resulted in markedly improved health outcomes (2-2.9 DALYs averted per woman, primarily due to reduced mortality), with net savings or extremely low cost per DALY averted. This suggests that in resource-limited settings, the NASG is a very cost-effective intervention for women in severe hypovolemic shock. The effects of the NASG for mild shock are less certain.
authors: University of Texas Southwestern Medical Center, Dallas, Texas, United States of America.
authors: Tori
authors: T
authors: Sutherland
authors: Janelle
authors: J
authors: Downing
authors: Suellen
authors: S
authors: Miller
authors: David M
authors: DM
authors: Bishai
authors: Elizabeth
authors: E
authors: Butrick
authors: Mohamed M F
authors: MM
authors: Fathalla
authors: Mohammed
authors: M
authors: Mourad-Youssif
authors: Oladosu
authors: O
authors: Ojengbede
authors: David
authors: D
authors: Nsima
authors: James G
authors: JG
authors: Kahn
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004534:Egypt / Q000453:epidemiology; D005260:Female; D005392:First Aid / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D009017:Morbidity; D009026:Mortality; D009549:Nigeria / Q000453:epidemiology; D011247:Pregnancy; D012771:Shock, Hemorrhagic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
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