Extending the uses of observational data on severe maternal morbidity: economic evaluation of second-line managements for postpartum haemorrhage

BackgroundRandomised controlled trials of treatments for conditions that are both rare and occur in emergency situations are particularly difficult owing to the time limitations in the emergency situation as well as the large collaboration needed to conduct studies of sufficient size. 126 Studies of effectiveness and particularly cost-effectiveness are thus rarely undertaken in this setting. National observational data, such as those obtained through UKOSS, have fewer of the biases classically attributed to many observational studies. 127 This information may therefore be used to explore effectiveness of different current treatments for near-miss maternal morbidities. In the absence of evidence from RCTs it is necessary to rely on these observational data, but given the known variation in the use of specific interventions, national recommendations will rely on these data supplemented by economic data. For example …