Objective: To determine the cost-effectiveness of prenatal iron supplementation and misoprostol use as interventions to prevent maternal mortality in home births in rural India. Methods: A cost-effectiveness analysis depicted three hypothetical cohorts of 10 000 pregnant women delivering at home in rural India: one with no intervention, one receiving standard prenatal iron supplements, and 1 receiving 600 μg of misoprostol in the third stage of labor. Results: Misoprostol used to prevent postpartum hemorrhage resulted in a 38% (95% CI, 5%–73%) decrease in maternal deaths, while prenatal iron supplementation resulted in a 5% (95% CI, 0%–47%) decrease. Misoprostol cost a median US $1401 (IQR US $1008–$1848) prenatal iron supplementation cost a median US $2241 (IQR No Lives Saved–$3882) per life saved compared with the standard care outcome. Conclusion: misoprostol is a cost-effective maternal mortality intervention for home births. Iron supplementation may be worthwhile to improve women's health, but it is uncertain whether it can prevent mortality after hemorrhage.
International Journal of Gynecology & Obstetrics (2009) 104 (3) 189-193 [doi:10.1016/j.ijgo.2008.10.011]