Cost‐effectiveness of prophylactic magnesium sulphate for 9996 women with pre‐eclampsia from 33 countries: economic evaluation of the Magpie Trial

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Abstract
Objective To assess the cost‐effectiveness of using magnesium sulphate for pre‐eclampsia to prevent eclampsia. Design Multinational trial‐based economic evaluation. Setting Thirty‐three countries participating in the Magnesium Sulphate for Prevention of Eclampsia (Magpie) Trial. Population Women (9996) with pre‐eclampsia from the Magpie Trial. Methods Outcome and hospital resource use data were available for the trial period from the Magpie Trial. Country‐specific unit costs (U.S. dollar, year 2001) were obtained subsequently from participating hospitals by questionnaire. Cost‐effectiveness was estimated for three categories of countries grouped by gross national income (GNI) into high, middle and low GNI countries using a regression model. Uncertainty was explored in sensitivity analyses. Main outcome measures Eclampsia, hospital care costs and the incremental cost per case of eclampsia prevented. Results The number of women with pre‐eclampsia who needed to receive magnesium sulphate to prevent one case of eclampsia was 324 [95% confidence interval (CI) 122, ∞] in high, 184 (95% CI 91, 6798) in middle and 43 (95% CI 30, 68) in low GNI countries. The additional hospital care cost per woman receiving magnesium sulphate was $65, $13 and $11, respectively. The incremental cost of preventing one case of eclampsia was $21,202 in high, $2473 in middle and $456 in low GNI countries. Reserving treatment for severe pre‐eclampsia would lower these estimates to $12,942, $1179 and $263. Conclusions Magnesium sulphate for pre‐eclampsia costs less and prevents more eclampsia in low GNI than in high GNI countries. Cost‐effectiveness substantially improves if it is used only for severe pre‐eclampsia, or the purchase price is reduced in low GNI countries.