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Grand Rounds

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

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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

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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?

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