Cost-Effectiveness of Carbetocin vs Oxytocin for Preventing Postpartum Hemorrhage in Women at High Risk for Postpartum Hemorrhage Undergoing Cesarean Section at Buddhachinaraj Phitsanulok Hospital

Background: Postpartum hemorrhage (PPH) is a serious and dangerous complication following a cesarean section that carries a significant risk of bleeding and can result in shock or death. Objective: To compare the cost-effectiveness of 100 mg of carbetocin with that of 10 units of oxytocin for the prevention of PPH in women at high risk for PPH undergoing cesarean section. Methods: A decision tree model was used to assess cost-effectiveness from societal and payer perspectives over a one-year time horizon, using a 3% discount rate and data from hospital records and published studies. Robustness was evaluated using with one-way and probabilistic sensitivity analyses. Results: From the societal perspective, carbetocin demonstrated a cost saving of ฿828.16 ($25.18) and yielded an incremental gain of 0.04 quality-adjusted life years (QALYs). In contrast, the payer’s perspective revealed an additional cost of ฿632.69, with an incremental cost-effectiveness ratio of ฿14 243.20 ($433.14) per QALY gained. Carbetocin was notably more effective in preventing severe PPH, with a prevention rate of 44.4% compared with 16.3% observed with oxytocin. Sensitivity analysis identified treatment response as the most influential factor in the economic model. Conclusions: Carbetocin is a cost saving and clinically effective option for managing PPH in women at high-risk for PPH undergoing cesarean section. Its performance remains within the acceptable willingness-to-pay threshold established by Thai context (฿160 000 per QALY), making it a viable candidate for broader policy inclusion.