Evaluación farmacoeconómica con modelización comparando dos esquemas terapéuticos con carbetocina y oxitocina para la prevención de la hemorragia postparto por cesárea (Lima, Perú)

Postpartum hemorrhage is one of the main causes of maternal death. Oxytocin has traditionally been used to prevent postpartum hemorrhage. Aim: To compare oxytocin with carbetocin, a long-acting analog of oxytocin, for prevention of uterine hemorrhage after cesarean delivery. Materials & methods: Clinical data were retrieved from the 2012 Cochrane meta-analysis “Carbetocin for preventing postpartum hemorrhage”. A decision tree was constructed. The direct costs were those of medications from the Peruvian official price list (DIGEMID). Costs associated with additional oxytocic drugs, blood transfusions, postpartum hemorrhage kits and hysterectomy were obtained from Hospital Nacional Edgardo Rebagliati Martins. The perspective of the study was that of the payer. The time horizon for calculating quality-adjusted life years (QALYs) was 1 year (2015). Results: Patients who received carbetocin required fewer additional uterotonic agents, had fewer hemorrhages and received fewer blood transfusions. Therefore, the costs associated with these interventions were lower. The incremental cost–effectiveness ratio was S/. 49,918 per QALY gained, which is lower than the threshold we estimated for Peru. Conclusion: Carbetocin is more cost-effective than oxytocin for prevention of uterine hemorrhage after cesarean delivery. La hemorragia postparto es una de las principales causas de mortalidad materna tanto en los países en desarrollo como en los desarrollados. Según la OMS, Cada día mueren en todo el mundo unas 800 mujeres por complicaciones relacionadas con el embarazo o el parto. Así mismo , se estima que la hemorragia postparto severa se presenta en alrededor del 11% de las mujeres que tiene parto de un nacido vivo (1). En el Perú, en el año 2015 se produjeron 414 muertes maternas y aproximadamente el 42 % es debido a hemorragia (16). Durante el año 2014, en el Seguro Social de salud del Perú (ESSALUD) se reportaron 49 muertes maternas, representando un 11% de las muertes maternas del país. La hemorragia uterina es la tercera causa de muerte materna en ESSALUD, puede presentarse hasta en un 10% del total de partos, 4% corresponden a partos vaginales y 6% a cesáreas (17). pre-print 543 KB