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

BJOG. 2006 Feb;113(2):144-51. doi: 10.1111/j.1471-0528.2005.00785.x.


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, infinity] 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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anticonvulsants / economics
  • Anticonvulsants / therapeutic use*
  • Cost-Benefit Analysis
  • Female
  • Hospitalization / economics
  • Humans
  • Internationality
  • Magnesium Sulfate / economics
  • Magnesium Sulfate / therapeutic use*
  • Pre-Eclampsia / drug therapy*
  • Pre-Eclampsia / economics
  • Pregnancy
  • Pregnancy Outcome
  • Treatment Outcome


  • Anticonvulsants
  • Magnesium Sulfate