A cost-effectiveness analysis of early detection and bundled treatment of postpartum hemorrhage alongside the E-MOTIVE trial

Timely detection and treatment of postpartum hemorrhage (PPH) are crucial to prevent complications or death. A calibrated blood-collection drape can help provide objective, accurate and early diagnosis of PPH, and a treatment bundle can address delays or inconsistencies in the use of effective interventions. Here we conducted an economic evaluation alongside the E-MOTIVE trial, an international, parallel cluster-randomized trial with a baseline control phase involving 210,132 women undergoing vaginal delivery across 78 secondary-level hospitals in Kenya, Nigeria, South Africa and Tanzania. We aimed to assess the cost-effectiveness of the E-MOTIVE intervention, which included a calibrated blood-collection drape for early detection of PPH and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination and escalation), compared with usual care. We used multilevel modeling to estimate incremental cost-effectiveness ratios from the perspective of the public healthcare system for outcomes of cost per severe PPH (blood loss ≥1,000 ml) avoided and cost per disability-adjusted life-year averted. Our findings suggest that the use of a calibrated blood-collection drape for early detection of PPH and bundled first-response treatment is cost-effective and should be perceived by decision-makers as a worthwhile use of healthcare budgets. ClinicalTrials.gov identifier: NCT04341662.

Eleanor V. Williams, Ilias Goranitis, Raymond Oppong, Samuel J. Perry, Adam J. Devall, James T. Martin, Kristie-Marie Mammoliti, Leanne E. Beeson, Kulandaipalayam N. Sindhu, Hadiza Galadanci, Fadhlun Alwy Al-beity, Zahida Qureshi, G. Justus Hofmeyr, Neil Moran, Sue Fawcus, Sibongile Mandondo, Lee Middleton, Karla Hemming, Olufemi T. Oladapo, Ioannis D. Gallos, Arri Coomarasamy, Tracy E. Roberts