Cost analysis of intrauterine balloon tamponade versus uterine artery embolization in the management of persistent postpartum hemorrhage

Abstract

Objective: The aim of this study was to compare the cost of a strategy initially resorting to intrauterine balloon tamponade versus a strategy initially resorting to uterine artery embolization in the management pathway of persistent postpartum hemorrhage.MethodsThis was a propensity score-matched cohort study including women who were subsequently treated with (scenario 1) versus uterine artery embolization (scenario 2) in order to control PPH, defined as postpartum bleeding that was resistant to first-line treatment. We compared these two scenarios in terms of cost. These were based on costs of intervention, blood products transfused, and intensive care unit admission. We calculated the mean cost difference between the scenarios per woman. Methods: This was a propensity score-matched cohort study including women who were subsequently treated with (scenario 1) versus uterine artery embolization (scenario 2) in order to control PPH, defined as postpartum bleeding that was resistant to first-line treatment. We compared these two scenarios in terms of cost. These were based on costs of intervention, blood products transfused, and intensive care unit admission. We calculated the mean cost difference between the scenarios per woman. Results: The propensity score-matched cohort comprised 50 women per scenario. In scenario 1, intrauterine balloon tamponade was successful in 29 women (58%), with a mean cost per patient of 7060 (standard deviation [SD], 2846). In scenario 2, uterine artery embolization was successful in 42 women (84%), with mean cost per patient of 7122 (SD, 2918). In each scenario, six women (12%) underwent a peripartum hysterectomy. The difference in mean cost per woman between the two scenarios was 62 in favor of scenario 1. Conclusion: There is a negligible difference in cost between scenarios in which women with PPH are initially managed with intrauterine balloon tamponade versus uterine artery embolization. Given the comparable cost and maternal outcomes, intrauterine balloon tamponade is a favorable treatment, considering its less invasive nature, practical considerations, and lower risk of complications.