142nd APHA Annual Meeting and Exposition

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306751
Non-pneumatic anti-shock garment (NASG): When and where to apply

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 5:10 PM - 5:30 PM

Janelle Downing, MS , Health Services and Policy Analysis, University of California, Berkeley, Berkeley, CA
Alison El Ayadi, ScD, 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
Elizabeth Butrick, MPH , Department of Obstetrics, Gynecology & Reproductive Sciences, 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
Audio (mp3) recording Recorded Presentation (mp4)
Objective: To use a comparative cost-effectiveness approach with evidence from four countries to understand which facility level is most appropriate for implementing the non-pneumatic anti-shock garment (NASG) to decrease maternal mortality associated with obstetric hemorrhage (OH).

Methods: Two data sources were compared. We determined the cost-effectiveness of NASG application for women with hypovolemic shock from OH at the referral hospitals (RH) compared to standard of care within a two-phase intervention study of 6 RH in Egypt and Nigeria. To specify the cost-effectiveness of applying the NASG at the primary health clinic (PHC) level compared to the RH, we estimated random-effects models within a cluster-randomized control trial of 38 primary health clinics (PHC) in Zambia and Zimbabwe. Costs (blood transfusions, medications, etc.) and disability-adjusted life years (DALYs) were compared across the intervention scenarios. 

Results: The NASG was cost saving ($77-85 per woman in Egypt) or very cost-effective ($3-6 per DALY averted in Nigeria) when applied at the referral hospital level. Applying the NASG at PHCs instead of waiting until the RH was very cost-effective ($19 per DALY averted in Zambia). We were unable to ascertain if the NASG was cost-effective in Zimbabwe due to low number of maternal deaths. Cost savings were mainly due to reduced blood transfusions.

Conclusion: For health systems with at least moderate clinical resource availability, the NASG is cost-effective or cost savings at the RH-level. Our evidence suggests that applying the NASG at the PHC is cost-effective for countries with a health system similar to Zambia.

Learning Areas:

Biostatistics, economics
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
Compare evidence from two cost-effectiveness studies where the non-pneumatic anti-shock garment (NASG) to decrease maternal mortality associated with obstetric hemorrhage (OH) is applied in different clinical and resource settings.

Keyword(s): International MCH, Evaluation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral student in Health Services and Policy Analysis with an emphasis in economics and population health. I have been a primary author of the cost-effectiveness studies on the non-pneumatic anti-shock garment (NASG).
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: 4442.0: International MCH New Approaches to Old Problems