title: Cost-effectiveness of condom uterine balloon tamponade to control severe postpartum hemorrhage in Kenya.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of condom uterine balloon tamponade (UBT) for control of severe postpartum hemorrhage (PPH) due to uterine atony versus standard PPH care in Kenya.
  
  
  METHODS
  A cross-sectional analysis was conducted using cost data collected from 30 facilities in Western Kenya from April 15 to July 16, 2015. Effectiveness data were derived from the published literature. The modeling analysis was performed from the health-system perspective for a cohort of women who gave birth in 2015. Sensitivity analyses tested the robustness of model estimates. Costs were in 2015 US dollars.
  
  
  RESULTS
  Compared with standard care with no uterine packing, condom UBT could prevent 1255 hospital transfers, 430 hysterectomies, and 44 maternal deaths. At $5 or $15 per UBT device, the incremental cost per disability-adjusted life year (DALY) averted was $26 or $40, respectively. If uterine packing was assumed to be done with standard care, the cost per DALY averted was $164 when the UBT price was $5 and $199 when the price was $15.
  
  
  CONCLUSIONS
  Condom UBT was a highly cost-effective intervention for controlling severe PPH. This finding remained robust even when key model inputs were varied by wide margins.
authors.affiliation: Devices and Tools Global Program, PATH, Seattle, WA, USA.
authors.forename: Mercy
authors.initials: M
authors.lastname: Mvundura
authors.affiliation: School of Medicine, Masinde Muliro University of Science and Technology, Kakamega, Kenya.
authors.forename: Donald
authors.initials: D
authors.lastname: Kokonya
authors.affiliation: Devices and Tools Global Program, PATH, Seattle, WA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Abu-Haydar
authors.affiliation: APHIAplus Western Kenya Project, PATH, Kisumu, Kenya.
authors.forename: Eunice
authors.initials: E
authors.lastname: Okoth
authors.affiliation: Strategy and Learning Management, PATH, Seattle, WA, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Herrick
authors.affiliation: APHIAplus Western Kenya Project, PATH, Kisumu, Kenya.
authors.forename: James
authors.initials: J
authors.lastname: Mukabi
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Carlson
authors.affiliation: Kisumu Medical and Educational Trust, Kisumu, Kenya.
authors.forename: Monica
authors.initials: M
authors.lastname: Oguttu
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Burke
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007630:Kenya; D008427:Maternal Health Services / Q000191:economics; D008428:Maternal Mortality; D018743:Perinatal Care / Q000191:economics; D006473:Postpartum Hemorrhage / Q000191:economics / Q000401:mortality / Q000628:therapy*; D011247:Pregnancy; D058738:Uterine Balloon Tamponade / Q000295:instrumentation*
keywords: Condom uterine balloon tamponade; Cost-effectiveness; Disability-adjusted life year; Economic evaluation; Kenya; Low-resource settings; Maternal hemorrhage; Postpartum hemorrhage