title: Carbetocin versus oxytocin for prevention of post-partum haemorrhage at caesarean section in the United Kingdom: An economic impact analysis.
abstract: OBJECTIVE
  To determine the economic impact of the introduction of carbetocin for the prevention of postpartum haemorrhage (PPH) at caesarean section, compared to oxytocin.
  
  
  METHODS
  The model is a decision tree conducted from a UK National Health Service perspective. 1500 caesarean sections (both elective and emergency) were modelled over a 12 month period. Efficacy data was taken from a published Cochrane meta-analysis, and costs from NHS Reference costs, the British National Formulary and the NHS electronic Medicines Information Tool. A combination of hospital audit data and expert input from an advisory board of clinicians was used to inform resource use estimates. The main outcome measures were the incidence of PPH and total cost over a one year time horizon, as a result of using carbetocin compared to oxytocin for prevention of PPH at caesarean section.
  
  
  RESULTS
  The use of carbetocin compared to oxytocin for prevention of PPH at caesarean section was associated with a reduction of 30 (88 vs 58) PPH events (>500ml blood loss), and a cost saving of £27,518. In probabilistic sensitivity analysis, carbetocin had a 91.5% probability of producing better outcomes, and a 69.4% chance of being dominant (both cheaper and more effective) compared to oxytocin.
  
  
  CONCLUSIONS
  At list price, the introduction of carbetocin appears to provide improved clinical outcomes along with cost savings, though this is subject to uncertainty regarding the underlying data in efficacy, resource use, and cost.
authors.affiliation: Academic Centre for Women's Health, North Bristol NHS Trust, Bristol, United Kingdom; School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, United Kingdom. Electronic address: helenvandernelson@gmail.com.
authors.forename: Helen A
authors.initials: HA
authors.lastname: van der Nelson
authors.affiliation: Academic Centre for Women's Health, North Bristol NHS Trust, Bristol, United Kingdom; School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Draycott
authors.affiliation: Academic Centre for Women's Health, North Bristol NHS Trust, Bristol, United Kingdom; School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, United Kingdom.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Siassakos
authors.affiliation: Academic Centre for Women's Health, North Bristol NHS Trust, Bristol, United Kingdom; School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, United Kingdom.
authors.forename: Christopher W H
authors.initials: CWH
authors.lastname: Yau
authors.affiliation: BresMed, 84 Queen Street, Sheffield, S1 2DW, United Kingdom; Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Hatswell
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects* / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D018803:Models, Economic; D010120:Oxytocics / Q000191:economics*; D010121:Oxytocin / Q000031:analogs & derivatives* / Q000191:economics*; D006473:Postpartum Hemorrhage / Q000191:economics / Q000517:prevention & control*
chemical_list: D010120:Oxytocics; D010121:Oxytocin; C020731:carbetocin
keywords: Carbetocin; Cost-effectiveness; Economic model; Postpartum haemorrhage