Carbetocin for the Prevention of Post-Partum Hemorrhage: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Details

Files
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:
RC1157-000

Question

  1. What is the clinical effectiveness of carbetocin for individuals undergoing cesarean delivery or having a vaginal delivery who are high risk for post-partum hemorrhage?
  2. What is the cost-effectiveness of carbetocin for individuals undergoing cesarean delivery or having a vaginal delivery who are high risk for post-partum hemorrhage?
  3. What is the evidence-based guidelines surrounding the use of carbetocin for individuals undergoing cesarean delivery or having a vaginal delivery who are high risk for post-partum hemorrhage?

Key Message

One systematic review of economic evaluations, two systematic reviews of effectiveness studies, seven randomized controlled trials, five non-randomized studies, two economic evaluations, and five guidelines were included. There is evidence to support the use of carbetocin for the prevention of post-partum hemorrhage (PPH) of 500 mL or greater, or 1,000 mL or greater based on a network meta-analysis. In a subgroup analysis and a smaller systematic review, carbetocin was more effective than oxytocin for PPH prevention for cesarean delivery, and not vaginal delivery. In the primary studies, carbetocin was associated with similar or more effectiveness regarding the prevention of PPH, reducing additional uterotonic use, or hemoglobin drops. In the systematic review of economic evaluations, carbetocin was more cost-effective than oxytocin for the prevention of PPH. From a UK perspective, carbetocin, oxytocin and another uterotonic agent were considered the most cost-effective strategies for preventing PPH. However, in a Columbian economic evaluation, carbetocin was less cost-effective for vaginal births than the cost-effectiveness threshold but was less costly and more effective for cesarean delivery. According to a 2018 Canadian guideline, carbetocin is recommended to prevent PPH for cesarean delivery and vaginal delivery with one PPH risk factor. Carbetocin is also considered first-line treatment in a 2018 German guideline. However, three guidelines published before 2018, including a Canadian guideline, do not recommend carbetocin or do not consider it as a first-line option. The limitations of this report included various definitions of PPH and risk factors, pending updates to a key network meta-analysis, and inconsistent guideline recommendations. For health policy making, the clinical effectiveness and cost-effectiveness of carbetocin needs to be further studied in Canadian contexts. The Canadian guidelines may also need to be updated with recent publications.