Early detection and treatment of postpartum haemorrhage: a cost-effectiveness analysis of the E-MOTIVE trial

BackgroundTimely detection and treatment of postpartum haemorrhage (PPH) are crucial to prevent complications or death. A calibrated blood-collection drape can help provide objective, accurate, and early diagnosis of PPH and a treatment bundle can address delays or inconsistencies in the use of effective interventions. MethodsWe conducted an incremental cost-effectiveness analysis alongside the E-MOTIVE trial, an international, parallel cluster-randomised trial with a baseline control phase, designed to assess a multi-component intervention for PPH in patients having vaginal delivery. We compared the E-MOTIVE intervention, which included a calibrated blood-collection drape for early detection of PPH and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), with usual care. We used multilevel modelling to estimate incremental cost-effectiveness ratios from the perspective of the public healthcare system for outcomes of cost per case of severe PPH (blood loss [≥]1000 mL) prevented and cost per disability-adjusted life-year (DALY) averted. ResultsA total of 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the E-MOTIVE group or the usual-care group. Among hospitals and patients with data, severe PPH was diagnosed in 1.6% of patients in the E-MOTIVE group and 4.3% of patients in the usual-care group (risk difference, -2.6%; 95% CI -3.1% to -2.1%). Mean DALYs per patient were lower for the E-MOTIVE group (-0.0027; 95% CI -0.0081 to 0.0029) whilst mean costs per patient were slightly higher compared with the usual-care group (0.30 USD; 95% CI -2.31 to 2.78). The E-MOTIVE intervention was deemed cost-effective at contemporary willingness-to-pay thresholds and remained cost-effective across the full range of sensitivity and country-level analyses. InterpretationUse of a calibrated blood-collection drape for early detection of PPH and bundled first-response treatment is cost-effective and should be perceived by decision makers as a worthwhile use of healthcare budgets. FundingBill & Melinda Gates Foundation (NCT04341662).