Analytical approach:
The authors used a published Monte-Carlo model to estimate the outcomes for mothers delivering in the community, with the alternative strategies, and to determine the clinical and economic impact of each strategy. The model used a combination of published evidence, regional data, and expert opinion. The authors stated that the perspective was that of the Indian health sector.
Effectiveness data:
The clinical effectiveness data for misoprostol treatment came from two published randomised controlled trials. The main clinical parameters were the decrease in postpartum haemorrhages and the control of haemorrhages.
Monetary benefit and utility valuations:
Not relevant.
Measure of benefit:
The primary measure of benefit was the number of disability-adjusted life-years (DALYs) gained. Secondary measures of benefit were used to calculate the DALYs and these were the number of years of life lost and the years of life lost due to disability.
Cost data:
The direct costs included the costs of training birth attendants, the delivery fees of birth attendants, and the costs of drugs. The costs of the attendants were from published studies, including one from the Indian community setting. The costs of drugs were based on international average prices from Management Sciences for Health, 2006. The currency was US dollars ($) and the price year was 2009.
Analysis of uncertainty:
Sensitivity analyses, based on parameter distributions assigned in the published model, were run over a series of iterations.
