Cost Comparison Shows Intrauterine Balloon Tamponade as Practical First-Line Option for Postpartum Hemorrhage: Study

The study analyzed the cost-effectiveness of two primary interventions for managing persistent postpartum hemorrhage (PPH): intrauterine balloon tamponade and uterine artery embolization. The findings suggest that while both strategies have similar financial implications, intrauterine balloon tamponade may offer practical advantages due to its less invasive approach.

Persistent PPH, defined as postpartum bleeding unresponsive to initial treatments, remains a significant cause of maternal morbidity. In the study, Lisanne R. Bonsen, Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands, and colleagues conducted a cost comparison between two clinical management strategies by retrospectively analyzing a matched cohort of women who underwent either intrauterine balloon tamponade (scenario 1) or uterine artery embolization (scenario 2).

The study involved a propensity score–matched sample of 100 women, with 50 patients in each group.

The key findings of the study were as follows:

• In the balloon tamponade group, bleeding was successfully controlled in 29 women, accounting for 58% of the group.
• The average cost per patient in this group was approximately €7060, with a standard deviation of €2846.
• In the embolization group, 42 women (84%) experienced successful bleeding control.
• The mean cost per patient in this group was €7122, with a standard deviation of €2918.
• Both groups had the same rate of peripartum hysterectomy, with six women (12%) undergoing the procedure in each group.
• The cost difference between the two approaches was minimal, with balloon tamponade being €62 less expensive on average.
• The negligible cost difference suggests that factors beyond economics should influence the choice of intervention.

Despite the slightly higher success rate of embolization, the researchers argue that intrauterine balloon tamponade is a favorable option. Its minimally invasive nature, ease of application, and potential for earlier use in the treatment pathway make it a practical first-line approach, especially in settings with limited access to interventional radiology services.

The study concludes that while both methods demonstrate near-equivalent costs and outcomes, intrauterine balloon tamponade should be considered a frontline strategy due to its safety profile and operational convenience. These findings could have significant implications for obstetric care protocols, particularly in resource-constrained environments.

"Overall, the research highlights the importance of integrating clinical effectiveness with cost considerations to optimize maternal health outcomes," the researchers wrote.

Reference:

Bonsen, L. R., Caram-Deelder, C., Ramler, P. I., Urlings, T., & A. Henriquez, D. C. Cost analysis of intrauterine balloon tamponade versus uterine artery embolization in the management of persistent postpartum hemorrhage. International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.70149