Retrospective cost-effectiveness analysis of carbetocin for the prevention of postpartum hemorrhage after vaginal birth: Evidence from a tertiary maternity center in France.
Carbetocin significantly reduced severe postpartum hemorrhage compared to oxytocin, but it comes with higher costs, leading to an incremental cost-effectiveness ratio of €511.87 per severe PPH avoided.
Where it sits
this study against the rest of the carbetocin corpusSummary and findings
This study assessed the cost-effectiveness of carbetocin for postpartum hemorrhage (PPH) prevention in vaginal deliveries. A total of 1404 women were analyzed, with 702 in each group during the oxytocin and carbetocin periods. Severe PPH occurred less frequently with carbetocin than with oxytocin, but the overall PPH rate was similar between groups.
Abstract
Objective Prophylactic oxytocin (5-10 IU) after vaginal birth is a grade A recommendation in France. During cesarean delivery, carbetocin is increasingly used as an alternative to oxytocin to reduce the risk and burden of postpartum hemorrhage (PPH). Its role after vaginal birth remains uncertain, largely because of higher costs. This study assessed the cost-effectiveness of carbetocin for PPH prevention in vaginal deliveries. Methods We performed a retrospective single-center, observational before-after cohort study with a medico-economic component in a French tertiary maternity unit. All women who delivered vaginally between January 1 and March 31, 2024 (oxytocin period), and between November 1, 2024, and January 31, 2025 (carbetocin period), were included. These two periods corresponded to the institutional protocol change replacing oxytocin with carbetocin for prophylaxis of postpartum hemorrhage after vaginal delivery. Results A total of 1404 women were analyzed (702 per group). The overall PPH rate was similar between groups (9.0% vs. 7.8%). Severe PPH (≥1000 mL) occurred less frequently with carbetocin than with oxytocin (1.3% vs. 3.0%, P = 0.0244). Weighted mean costs per patient were €17.28 in the carbetocin group and €9.07 in the oxytocin group, with a mean difference of €8.11 (95% confidence interval [CI]: 0.31-15.48). The incremental cost-effectiveness ratio (ICER) was €511.87 per severe PPH avoided. Conclusion Despite higher drug costs, prophylactic carbetocin significantly reduced severe PPH compared with oxytocin and showed favorable cost-effectiveness in vaginal deliveries. These findings support carbetocin as a valuable alternative for PPH prevention in this setting.
Background
This paper addresses the cost-effectiveness of carbetocin compared to oxytocin for preventing postpartum hemorrhage (PPH) after vaginal births. Prophylactic oxytocin is a standard recommendation in France, but carbetocin's role remains uncertain due to higher costs. Understanding the economic implications of using carbetocin is important for clinical decision-making in maternity care.
Methods
The study utilized a retrospective, single-center, observational before-after cohort design. It included women who delivered vaginally during two distinct periods: January 1 to March 31, 2024 (oxytocin period) and November 1, 2024, to January 31, 2025 (carbetocin period). The primary outcome was the rate of severe PPH, while secondary outcomes included overall PPH rates and cost analysis.
Results
The primary endpoint showed that severe PPH occurred less frequently with carbetocin (1.3%) compared to oxytocin (3.0%), with a p-value of 0.0244. The overall PPH rates were 9.0% for oxytocin and 7.8% for carbetocin. The mean costs per patient were €17.28 for carbetocin and €9.07 for oxytocin, resulting in a mean difference of €8.11 (95% CI: 0.31-15.48). The ICER was calculated at €511.87 per severe PPH avoided.
Interpretation
The findings suggest that while carbetocin is associated with a lower rate of severe PPH, the clinical significance of this reduction should be weighed against the higher costs. The effect size for severe PPH reduction is statistically significant, but the clinical relevance may be limited given the small absolute difference. The study's observational design and single-center nature introduce potential confounds that could affect the generalizability of the results.
Key findings
- Overall PPH rate was similar between groups (9.0% vs. 7.8%).
- Severe PPH (≥1000 mL) occurred less frequently with carbetocin than with oxytocin (1.3% vs. 3.0%, P=0.0244).
- Weighted mean costs per patient were €17.28 in the carbetocin group and €9.07 in the oxytocin group.
- Mean difference in costs was €8.11 (95% CI: 0.31-15.48).
- The incremental cost-effectiveness ratio (ICER) was €511.87 per severe PPH avoided.
Limitations
- single-center study limits generalizability
- observational design may introduce confounding
- does not account for long-term outcomes
- short follow-up period