Cost Effectiveness of Misoprostol vs. Iron

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This presentation was given by Bishai and Sutherland to the International Health Economics Association Conference 2009 in Beijing. It is research conducted as part of the Future Health Systems Research Programme Consortium www.futurehealthsystems.org.

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Cost Effectiveness of Misoprostol vs. Iron

  1. 1. Cost Effectiveness of Misoprostol vs. Iron David Bishai, Tori Sutherland Presenter’s Name Date 11 July 2009
  2. 2. Outline •Research question •Background on misoprostol •Methods results Presenter’s Name Date
  3. 3. Maternal mortality in India •Maternal mortality 540/100,000 in India •36% of deaths due to post partum hemorrhage •As of 2003 40% of Indian woman deliver at skilled facilities. –Numbers increasing due to Accredited Social Health Presenter’s Name Activist (ASHA) project offering vouchers Date
  4. 4. Role of Misoprostol • A $0.33 tablet for oral, vaginal, or rectal administration •Causes uterine contractions that can stop bleeding •Should not be used until placenta is out •Not as effective as intravenous oxytocin, BUT –Midwives can be trained to administer it for home births Presenter’s Name  Can lower hemorrhage rates by 50-80% in home births Date  Unknown how many lives saved •Until institutional deliveries are universal misoprostol can improve outcomes for home births
  5. 5. Role of Iron •Iron deficiency anemia affects about 62% of pregnant women in India •With hemoglobin levels low there is less reserve in case of hemorrhage •Pre natal iron can build up a higher reserve and in theory lower mortality Presenter’s Name Date
  6. 6. Question •Which approach offers cheaper $ per DALY? –Iron supplementation –Misoprostol at home births •Will need model to translate hemorrhage rates to Presenter’s Name death rates. Date
  7. 7. Step 1)Prenatal iron Presenter’s Name Date Iron can shift left tail of curve to right
  8. 8. Step 2) Misoprostol DEATH ZONE Presenter’s Name Date Misoprostol can shift bleeding curve to the left
  9. 9. Step 3) Day 1 deaths from shock Presenter’s Name Date
  10. 10. Step 4) Day 2 deaths from anemia Death Zone Presenter’s Name Date
  11. 11. Model •Monte Carlo Model •10,000 Indian Women having a delivery at home •Stata program applies hemoglobin distributions, blood loss distributions, and death distributions stochastically. Presenter’s Name –Sensitivity analysis applied Date
  12. 12. Results Scenario Deaths Lives Cost per Incremental Median per 10K saved 10,000 costs ICER No 19.5 $20,000 Interventio n Iron 18.4 1.4 $29,032 $9,032 $2,241 Presenter’s Name Misoprostol 12Date 7.5 $30,232 $10,232 $1,401 $1401 per life saved with misoprostol strategy
  13. 13. Sensitivity analysis With day 1 mortality +/- 20% misoprostol ICER fluctuates from $1,133 to $1,696 With day 2 mortality +/- 20% ICER ranges $1334 to $1429 Presenter’s Name Date
  14. 14. Discussion •Possible to estimate changes in death rates based on changes in hemorrhage rates using models of shock and anemia •Both misoprostol and pre natal iron are very in expensive Presenter’s Name $ per life saved in terms of Date –Misoprostol could be a game changer in terms of a vertical intervention that could be put in the hands of a traditional birth attendant.

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