Economic evaluation of different second-line therapies for peripartum haemorrhage
Randomised controlled trials of treatments for conditions which are both rare and occur in emergency situations are particularly difficult due to issues of informed consent as well as the large collaboration needed to conduct studies of sufficient size. Studies of effectiveness and particularly cost-effectiveness are thus rarely undertaken in this setting. National observational data, such as those obtained through UKOSS have fewer of the biases classically attributed to observational studies. This information may therefore be used to assess effectiveness of different current treatments for near-miss maternal morbidities. However, given the known variation in the use of specific interventions, national recommendations will rely on these data supplemented by economic data. For example, providing uterine artery embolisation for post-partum haemorrhage involves substantial capital outlay associated with the provision of a dedicated out-of-hours interventional radiology service. A national observational study collecting information on health outcomes in women managed with three second-line treatments for severe peripartum haemorrhage (B-Lynch or brace sutures, factor VIIa, major vessel embolisation or ligation) has recently been completed. This project will undertake a preliminary modelling analysis to explore the use of these previously collected observational data and other data obtained through literature review to conduct an economic evaluation of these therapies.