A recent analysis from 78 hospitals worldwide reveals that a lifesaving package, including early detection and bundled treatment for women experiencing heavy bleeding during childbirth, incurs minimal additional costs. The findings, published today in Nature Medicine, stem from the E-MOTIVE trial, which sought to determine the cost-effectiveness of interventions designed to identify and treat postpartum hemorrhage (PPH).
The economic analysis included over 200,000 women from hospitals in four African countries, with facilities randomly assigned to either the intervention group or the usual care group. The intervention package, which featured a calibrated blood collection drape to measure blood loss objectively, resulted in over 1,000 fewer PPH cases compared to the usual care group. After adjusting for various clinical factors and time-period considerations, the additional cost of the E-MOTIVE package was found to be approximately $0.30 per patient.
Key to the E-MOTIVE package is the calibrated blood collection drape, used for all women in the intervention group to measure blood loss accurately. The analysis indicated that if the cost of the drape is around $1, the average cost per patient could align closely with that of usual care.
“E-MOTIVE is clearly a cost-effective intervention for what is a lifesaving treatment for thousands of women around the world who may experience severe bleeding in childbirth,” said Tracy Roberts, Professor of Health Economics at the University of Birmingham and corresponding author of the study. “Our analysis shows that the costs incurred in delivering the package of treatments and the drape are minimal and represent excellent value for money.”
Roberts emphasized that widespread adoption of E-MOTIVE and further reduction in the cost of drapes to below $1 could enhance the economic benefits, potentially making the cost of delivering the intervention equivalent to that of usual care, thereby offering significant health benefits for women globally.
60% Reduction in Severe Bleeding
The cost-effectiveness finding follows a landmark study demonstrating a 60% reduction in severe bleeding for women experiencing PPH when treated with the E-MOTIVE package. PPH, defined as the loss of more than 500 mL of blood within 24 hours after birth, is the leading cause of maternal mortality worldwide, affecting an estimated 14 million women annually and resulting in approximately 70,000 deaths, predominantly in low and middle-income countries.
The study highlighted that objectively measuring blood loss with a low-cost drape and bundling WHO-recommended treatments—rather than administering them sequentially—led to dramatic improvements in outcomes. Severe bleeding, defined as losing more than a liter of blood after birth, was reduced by 60%, and the need for blood transfusions, a scarce and expensive resource in low-income countries, was also significantly decreased.
Professor Arri Coomarasamy, who led the E-MOTIVE trial and co-directs the WHO Collaborating Centre on Global Women’s Health at the University of Birmingham, remarked, “This new approach to treating postpartum hemorrhage could radically improve women’s chances of surviving childbirth globally. Time is critical when responding to postpartum bleeding, so interventions that eliminate delays in diagnosis or treatment should be game-changers for maternal health.”
With the latest study affirming E-MOTIVE’s cost-effectiveness and WHO’s endorsement of the treatment bundle, Coomarasamy expressed hope that the intervention would soon become the global standard of care, thereby saving countless lives.
