Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #104716

Linda Fogarty, PhD¹, Judith T. Fullerton, PhD, CNM, FACNM², Kevin D. Frick, PhD³, Joy D. Fishel, MPH¹, and Donna Vivio, CNM, MS, MPH⁴. (1) Maternal and Child Health Center of Excellence, JHPIEGO Corporation, 1615 Thames Street, Baltimore, MD 21231-3492, 410-537-1965, lfogarty@jhpiego.net, (2) Project Concern International, 5151 Murphy Canyon Road, #320, San Diego, CA 92123, (3) Department of Health Policy and Management, Johns Hopkins University, 624 N. Broadway, Rm. 606, Baltimore, MD 21205, (4) Maternal and Child Health Center of Excellence, JHPIEGO, 1615 Thames Street, Baltimore, MD 21231

Objective: To calculate the cost savings of using active management of the third stage of labor (AMTSL) rather than expectant management of the third stage of labor (EMSTL) for a population of mothers delivering babies in Latin American and sub-Saharan African settings, specifically Guatemala and Zambia. Methods: Expert opinion, publicly available data, and previous literature were combined to provide probabilities of events for the cost-effectiveness analysis. The costs of clinical events were calculated based on Ministry of Health prices (converted to 2004 U.S. dollars), observation of resources used in AMTSL and in EMTSL, and expert estimates of resources used in managing postpartum hemorrhage (PPH) and its complications, including transfusion. A simple decision tree was used to model expected costs associated with PPH given AMTSL or EMSTL. The expected cost savings from avoiding various PPH management strategies were compared with the extra costs of routinely providing AMTSL rather than EMTSL. Sensitivity analyses were conducted including varying the probability of the use of various PPH management strategies and calculating the minimum improvement in PPH incidence associated with AMTSL that would yield non-negative net benefits. Findings: The base case analysis in both countries suggested a positive net benefit from AMTSL, with a net cost savings of $18,000 in Guatemala (with 100 lives saved) and $145,000 in Zambia (with 467 lives saved) for 100,000 births. Conclusion: Facilities have strong economic incentives to adopt AMTSL if uterotonics are available.

Learning Objectives:

• Describe a health facility practice found to be cost saving in Guatemala and Zambia

Keywords: Cost-Effectiveness, Maternal Health

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation