259893 Non-pneumatic anti-shock garment (NASG) for obstetric hemorrhage: Cost savings and mortality reductions for women in severe shock

Wednesday, October 31, 2012 : 11:00 AM - 11:15 AM

Tori Sutherland, MPH , School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
Janelle Downing, MS , Philip R Lee Institute for Health Policy Studies and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
James G. Kahn, MD , Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
David Bishai, MD MPH PhD , Department of Population and Family Health Sciences, Bloomberg School of Public Health, Baltimore, MD
Elizabeth Butrick, MPH , Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA
Suellen Miller, PhD, CNM , Dept. Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health and Policy, University of California, San Francisco, San Francisco, CA
  
Objective: To assess the cost-effectiveness of non-pneumatic anti-shock garments (NASG) for obstetric hemorrhage in tertiary hospitals in Egypt and Nigeria.

Methods: Results from published pre-intervention/NASG-intervention phase trials for women in severe shock (mean arterial pressure (MAP)<60) were standardized for 1,000 women. Clinical data included frequencies of health outcomes (mortality, major morbidity, severe anemia), and interventions to control bleeding (uterotonics, blood transfusions, hysterectomies). Costs (2010 international dollars) included the NASG, training, and clinical interventions. Changes in cost, morbidity, mortality, and disability-adjusted life years (DALYs) were used to calculate incremental cost-effectiveness ratios (ICERs; cost per DALY averted) for each country and study phase. We examined hysterectomies for all etiologies and for intractable uterine atony only.

Results: Women with severe shock who received the NASG had lower mortality and morbidity, blood loss, uterotonics, and blood transfusions. On a per-case-basis, the NASG averted 2.095 DALYs in Egypt and 2.829 in Nigeria. The NASG saved $85.36 per-case in Egypt, which was primarily due to the reduction in blood transfusions. In Nigeria, the NASG had a net cost $16.04 per case, and cost $5.67 per DALY averted.

Conclusion: The NASG sharply improved health outcomes (primarily due to reduced mortality) and reduced treatment resources needed to manage severe hypovolemic shock. The NASG resulted in net savings or extremely low cost per DALY averted, which suggests it may be a cost-effective intervention in resource-limited settings.

Learning Areas:
Clinical medicine applied in public health
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
1. To assess the cost-effectiveness of non-pneumatic anti-shock garments (NASG) for obstetric hemorrhage in tertiary hospitals in Egypt and Nigeria. 2. To identify key cost variables for women with life-threatening obstetric hemorrhage that can be decreased with intervention and/or adherence to evidence-based care guidelines

Keywords: Maternal Health, Mortality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the corresponding author for this manuscript and have been involved with the analysis and the writing of the manuscript on the cost-effectiveness of the non-pneumatic anti-shock garment (NASG) in Egypt and Nigeria. I am also involved with two additional on-going cost-effectiveness analyses on the NASG. As a PhD student, my research interests include health economics and women's health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5141.0: Improving outcomes in delivery and postpartum care