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

METHODS:

• 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)

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

Tranexamic Acid in the Routine Treatment of Post-Partum Hemorrhage in the United States: A Cost-Effectiveness Analysis

Related ObG Topics:

Results From the Landmark Trial on Tranexamic Acid for Postpartum Hemorrhage

Does Prophylactic TXA Reduce Postpartum Hemorrhage?

Does Tranexamic Acid Reduce Blood Loss During Myomectomy?