title: Potential Cost-Effectiveness of Prenatal Distribution of Misoprostol for Prevention of Postpartum Hemorrhage in Uganda.
abstract: BACKGROUND
  In settings where home birth rates are high, prenatal distribution of misoprostol has been advocated as a strategy to increase access to uterotonics during the third stage of labor to prevent postpartum hemorrhage (PPH). Our objective was to project the potential cost-effectiveness of this strategy in Uganda from both governmental (the relevant payer) and modified societal perspectives.
  
  
  RESULTS
  To compare prenatal misoprostol distribution to status quo (no misoprostol distribution), we developed a decision analytic model that tracked the delivery pathways of a cohort of pregnant women from the prenatal period, labor to delivery without complications or delivery with PPH, and successful treatment or death. Delivery pathway parameters were derived from the Uganda Demographic and Health Survey. Incidence of PPH, treatment efficacy, adverse event and case fatality rates, access to misoprostol, and health resource use and cost data were obtained from published literature and supplemented with expert opinion where necessary. We computed the expected incidence of PPH, mortality, disability adjusted life years (DALYs), costs and incremental cost effectiveness ratios (ICERs). We conducted univariate and probabilistic sensitivity analyses to examine robustness of our results. In the base-case analysis, misoprostol distribution lowered the expected incidence of PPH by 1.2% (95% credibility interval (CrI): 0.55%, 1.95%), mortality by 0.08% (95% CrI: 0.04%, 0.13%) and DALYs by 0.02 (95% CrI: 0.01, 0.03).” and “ICERs were US$181 (95% CrI: 81, 443) per DALY averted from a governmental perspective, and US$64 (95% CrI: -84, 260) per DALY averted from a modified societal perspective [corrected].
  
  
  CONCLUSIONS
  Prenatal distribution of misoprostol is potentially cost-effective in Uganda and should be considered for national-level scale up for prevention of PPH.
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, Washington, United States of America.|Global Medicines Program, Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Solomon J
authors.initials: SJ
authors.lastname: Lubinga
authors.affiliation: Department of Pharmacology, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Esther C
authors.initials: EC
authors.lastname: Atukunda
authors.affiliation: Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda.
authors.forename: George
authors.initials: G
authors.lastname: Wasswa-Ssalongo
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, Washington, United States of America.|Global Medicines Program, Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Babigumira
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008423:Maternal Age; D008875:Middle Aged; D016595:Misoprostol / Q000191:economics / Q000627:therapeutic use*; D009774:Obstetrics / Q000379:methods; D010120:Oxytocics / Q000191:economics / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000191:economics / Q000517:prevention & control*; D049590:Postpartum Period; D011247:Pregnancy; D011295:Prenatal Care; D011336:Probability; D019057:Quality-Adjusted Life Years; D014454:Uganda; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol