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Recording

Oral Plenary Session I and Late-Breaking

Oral Plenary Sessions

(4) Cost-effectiveness of Azithromycin for the Prevention of Maternal Sepsis or Death in Planned Vaginal Births

Monday, February 12, 2024
4:30 PM – 4:45 PM  
Location: Potomac Ballroom, Ballroom Level
Objective: Maternal sepsis is one of the top three causes of maternal death globally. In a multi-country randomized trial performed by the National Institute of Child Health and Human Development’s Global Network for Women’s and Children’s Health Research, a single oral dose of azithromycin significantly reduced the risk of maternal sepsis or death in low- and middle-income countries (LMICs). To support policymakers considering recommendations regarding intrapartum azithromycin in LMICs, we estimate the cost per case of maternal sepsis or death averted, and the incremental cost of the intervention after accounting for cost-savings from reduced healthcare use.

Study Design:

In this cost-effectiveness analysis, we compared the costs and effects of azithromycin versus standard care using a probabilistic decision tree model informed by published results and primary data from the Azithromycin Prevention in Labor Use (A-PLUS) trial. From a healthcare sector perspective, we considered the costs of azithromycin treatment and its effect on maternal outcomes and healthcare use related to infection. We used country-specific costs and considered Zambia the median country based on the cost per day for hospital stays. Our model results represent the average of 100,000 model runs, each using a randomly selected set of parameters drawn from model distributions.

Results: Azithromycin resulted in 769 maternal sepsis or death cases averted, 809 maternal infections averted and 495 maternal hospitalizations averted per 100,000 pregnancies (Table). The cost of the intervention was $90,963 per 100,000 pregnancies, or $0.91 per pregnancy. The reduction in healthcare use resulted in cost-savings for all countries except Bangladesh (which had the lowest cost for healthcare use).  The median country cost-savings was $18,451 per 100,000 pregnancies.  

Conclusion: Azithromycin in women planning a vaginal birth is a cost-saving, effective treatment to reduce maternal sepsis or death and maternal infection. This cost-savings strengthens the evidence in support of implementing azithromycin in intrapartum care in LMICs.