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Carbetocin In Prevention of Uterine Atony Following Delivery by Cesarean Section in Population Who Experienced Postpartum Hemorrhage: Costs in Polish Settings

2016; Elsevier BV; Volume: 19; Issue: 3 Linguagem: Inglês

10.1016/j.jval.2016.03.1435

1524-4733

K Pacocha, Izabela Pieniążek, Maciej Sobkowski, Zbigniew Celewicz, Jarosław Kalinka, Krzysztof Szymanowski, Marcin Serafin, K Szpak, Anna Grzymała-Figura, J Walczak, Adam Bierut, W. Izbicki,

Maternal and fetal healthcare

The aim of the study was to estimate costs and consequences of carbetocin use in prevention of uterine atony following delivery by Cesarean section in comparison to standard methods (oxytocin) in Poland. A retrospective study based on patient medical records was conducted in three reference medical centres in Poland (Lodz, Poznan, Police). Costs and resource use data were gathered via electronic questionnaire for patients with/without risk of postpartum hemorrhage (PPH). This paper focuses on subpopulations who experienced PPH to evaluate whether carbetocin use instead of oxytocin may bring savings for the hospital. 132 out of 275 medical records concerned patients who experienced severe or other than severe PPH (4 subpopulations of patients depending on risk status and PPH severity). Since the characteristics of patients in chosen centres were consistent, pooling and averaging the data was methodologically justified. In each subpopulation costs incurred by the hospital were lower for carbetocin arm versus oxytocin. The highest difference was observed in patients who experienced severe PPH. Using carbetocin instead of oxytocin, the hospital could save 652 USD and 1,523 USD respectively for patients without/with the risk of PPH. In 3 out of 4 subpopulations, costs of delivery and PPH management were underestimated by the National Health Fund (NHF), what resulted in the higher deficit in the hospital’s budget. The mean underestimation of severe PPH unit cost by NHF amounts 1453 USD. Although the hospital could generate savings from carbetocin use, costs were not covered by NHF. Nevertheless, losses for the hospital were lower with carbetocin use. Prophylaxis of PPH following Caesarean delivery using carbetocin is relevant from both patients and hospital perspective. In the first case it helps to avoid traumatic and life threatening situation. In the second case, it is especially important because of limited hospitals’ budget.