Grand Rounds

Cost-Effectiveness of Routine TXA Treatment for PPH in the US

BACKGROUND AND PURPOSE:

Sudhof et al. (AJOG, 2019) examined the cost-effectiveness of routine TXA administration for PPH in the US, where the rate of hemorrhage-related mortality is lower than in the WOMAN trial

Cost-effectiveness analysis
- Perspective from healthcare institution perspective
Decision tree comparing 3 strategies in women with PPH
- No TXA
- TXA given at any time
- Ideal use of TXA given within 3 hours of delivery
Time window: Delivery until 6 weeks post-partum
The authors incorporated probabilities and costs based on available data for a population of women with PPH in the US
Base rate of PPH-related mortality: 0.0388%, Cost of TXA was $37.80
Authors used the WOMAN trial for the following when TXA was used
- Relative risk reduction for death: 19%
- Relative risk reduction for laparotomy: 36%
Primary outcome
- Incremental cost per hemorrhage-related death averted
Secondary outcome
- Incremental cost per laparotomy avoided under each strategy
- Cost per quality-adjusted life year (QALY)

TXA strategies were more effective and cost-saving compared to no TXA for patients with PPH in the US
Reduction in PPH related mortality
- TXA is cost-saving if the relative risk reduction of death with TXA is >4.7% percent
- The model was not sensitive to any other variables
Reduction in laparotomy
- TXA is cost-saving if the relative risk reduction of laparotomy with TXA is greater than 7% or the cost of TXA is <$194
Authors estimate that for routine use of TX for PPH treatment in the US
- Annual net cost savings expected is $11.3 million
- 9 maternal deaths would be averted in one year
Giving TXA within three hours (ideal dosing) would almost triple the cost savings and improve maternal outcomes much further

Routine use of TXA in the treatment of PPH is likely to be cost-effective in the US even if relative risk reduction is less and TXA cost is more than the WOMAN study

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