title: Cost-effectiveness of two interventions for the prevention of postpartum hemorrhage in Senegal.
abstract: OBJECTIVE
  To compare, at the community level, the cost-effectiveness of oxytocin and misoprostol for the prevention of postpartum hemorrhage (PPH).
  
  
  METHODS
  The present cost-effectiveness study used data collected during a randomized trial that compared the prophylactic effectiveness of misoprostol and oxytocin for the prevention of PPH in a rural setting in Senegal between June 6 and September 21 2013. The two interventions were compared, with referral to a higher level facility owing to PPH being the outcome measure. The costs and effects were calculated for two hypothetical cohorts of patients delivering during a 1-year period, with each cohort receiving one intervention. A comparison with a third hypothetical cohort receiving the current standard of care was included. A sensitivity analysis was performed to estimate the impact of variations in model assumptions.
  
  
  RESULTS
  The cost per PPH referral averted was US$ 38.96 for misoprostol and US$ 119.15 for oxytocin. In all the scenarios modeled the misoprostol intervention dominated, except in the worst-case scenario, where the oxytocin intervention demonstrated slightly better cost-effectiveness.
  
  
  CONCLUSIONS
  The use of misoprostol for PPH prophylaxis could be cost effective and improve maternal outcomes in low-income settings.
authors.affiliation: Guttmacher Institute, New York, USA. Electronic address: mvlassoff@guttmacher.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Vlassoff
authors.affiliation: Independent consultant, Dakar, Senegal.
authors.forename: Alioune
authors.initials: A
authors.lastname: Diallo
authors.affiliation: Guttmacher Institute, New York, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Philbin
authors.affiliation: Guttmacher Institute, New York, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Kost
authors.affiliation: Guttmacher Institute, New York, USA.
authors.forename: Akin
authors.initials: A
authors.lastname: Bankole
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000191:economics* / Q000627:therapeutic use; D010120:Oxytocics / Q000191:economics* / Q000627:therapeutic use; D010121:Oxytocin / Q000191:economics* / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D012017:Referral and Consultation; D012675:Senegal
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin
keywords: CEA; Cost-effectiveness; Misoprostol; Oxytocin; PPH; Postpartum hemorrhage; Senegal