Evaluación farmacoeconómica con modelización comparando dos esquemas terapéuticos con carbetocina y oxitocina para la prevención de la hemorragia postparto por cesárea (Lima, Perú).

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Abstract

Postpartum hemorrhage is one of the main causes of maternal death. Oxytocin has traditionally been used to prevent postpartum hemorrhage. Aim: To compare oxytocin with carbetocin, a long-acting analog of oxytocin, for prevention of uterine hemorrhage after cesarean delivery. Materials & methods: Clinical data were retrieved from the 2012 Cochrane meta-analysis “Carbetocin for preventing postpartum hemorrhage”. A decision tree was constructed. The direct costs were those of medications from the Peruvian official price list (DIGEMID). Costs associated with additional oxytocic drugs, blood transfusions, postpartum hemorrhage kits and hysterectomy were obtained from Hospital Nacional Edgardo Rebagliati Martins. The perspective of the study was that of the payer. The time horizon for calculating quality-adjusted life years (QALYs) was 1 year (2015). Results: Patients who received carbetocin required fewer additional uterotonic agents, had fewer hemorrhages and received fewer blood transfusions. Therefore, the costs associated with these interventions were lower. The incremental cost–effectiveness ratio was S/. 49,918 per QALY gained, which is lower than the threshold we estimated for Peru. Conclusion: Carbetocin is more cost-effective than oxytocin for prevention of uterine hemorrhage after cesarean delivery.