Use of Tranexamic Acid in Trauma Patients: An Analysis of Cost-Effectiveness for Use in Brazil

PINTO, Marcelo A.; SILVA, Jair G. da; Chedid, Aljamir Duarte; Chedid, Marcio

doi:10.1590/0102-6720201600040017

Cited by 10 publications

(5 citation statements)

References 28 publications

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“…As this is the first trial‐based economic evaluation of tranexamic acid for prevention of postpartum haemorrhage, it is difficult to compare our results with the literature. Nonetheless, previous economic evaluations support the use of tranexamic acid for treatment of postpartum haemorrhage 15,16 or for excessive blood loss in other patient groups, including treatment of patients with bleeding trauma and those who have had elective surgery 17,18 . Moreover, as other authors, 5 we found that the cost of vaginal deliveries was higher for those with the complication of excessive blood loss than for those with non‐excessive blood loss, this difference being mainly driven by a higher cost related to additional uterotonic drugs, blood products and embolisation or surgery to control PPH.…”

Section: Discussionsupporting

confidence: 59%

“…Nonetheless, previous economic evaluations support the use of tranexamic acid for treatment of postpartum haemorrhage 15,16 or for excessive blood loss in other patient groups, including treatment of patients with bleeding trauma and those who have had elective surgery. 17,18 Moreover, as other authors, 5 we found that the cost of vaginal deliveries was higher for those with the complication of excessive blood loss than for those with non-excessive blood loss, this difference being mainly driven by a For each cost item, the total cost for the population of interest was divided by the total number of women in the population, with the corresponding n-value at the top of the column. All costs are in € rounded to the nearest unit.…”

Section: Main Findingssupporting

confidence: 55%

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An economic evaluation of tranexamic acid to prevent postpartum haemorrhage in women with vaginal delivery: the randomised controlled TRAAP trial

Durand-Zaleski

Deneux‐Tharaux

Seco

et al. 2020

BJOG

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Objective To estimate the cost-effectiveness of tranexamic acid (TXA) use to prevent postpartum haemorrhage. Design A trial-based economic evaluation. Setting Fifteen French university maternity hospitals. Population Women enrolled in the TRAAP randomised controlled trial comparing TXA versus placebo in women with vaginal delivery. TRAAP failed to show a reduction in postpartum haemorrhage of at least 500 ml in the intervention arm but evidenced significant lower rates of secondary outcomes related to blood loss. Methods & main outcome measures We estimated direct medical costs from within-trial hospital resources collected prospectively from the study report form. All resources were costed at their value to the hospital. We estimated incremental cost per incremental haemorrhage averted. Results Among the 4079 women in the TRAAP trial, data necessary to calculate costs were available for 3836 (94.0%). The average total costs in the TXA and control groups were €2278 AE 388 and €2288 AE 409 per woman, respectively (P = 0.79). In women with postpartum haemorrhage of at least 500 ml (trial primary endpoint), costs were €2359 AE 354 and €2409 AE 525 (P = 0.14); for provider-assessed clinically significant postpartum haemorrhage and postpartum haemorrhage of at least 1000 ml, costs were respectively €2316 AE 347 versus €2381 AE 521 (P = 0.22) and €2321 AE 318 versus €2411 AE 590 (P = 0.35) in the tranexamic and placebo groups, respectively. The probabilistic sensitivity analysis showed that the use of TXA had a 65-73% probability of saving costs and improving outcome. Conclusions Our findings support the use of TXA, as both bleeding events and cost may be reduced three out of four times.

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Section: Discussionsupporting

confidence: 59%

Section: Main Findingssupporting

confidence: 55%

An economic evaluation of tranexamic acid to prevent postpartum haemorrhage in women with vaginal delivery: the randomised controlled TRAAP trial

Durand-Zaleski

Deneux‐Tharaux

Seco

et al. 2020

BJOG

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“…Although this is the first analysis to evaluate the cost-effectiveness of tranexamic acid for treatment of post-partum haemorrhage, our findings are broadly consistent with those of previous economic evaluations that have shown the cost-effectiveness of tranexamic acid for treatment of excessive blood loss in other patient groups, including treatment of patients with bleeding trauma and those who have had elective surgery. 24 , 25 , 26 …”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid for treatment of women with post-partum haemorrhage in Nigeria and Pakistan: a cost-effectiveness analysis of data from the WOMAN trial

Miners

Shakur

et al. 2018

The Lancet Global Health

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SummaryBackgroundSub-Saharan Africa and southern Asia account for almost 85% of global maternal deaths from post-partum haemorrhage. Early administration of tranexamic acid, within 3 h of giving birth, was shown to reduce the risk of death due to bleeding in women with post-partum haemorrhage in the World Maternal Antifibrinolytic (WOMAN) trial. We aimed to assess the cost-effectiveness of early administration of tranexamic acid for treatment of post-partum haemorrhage.MethodsFor this economic evaluation we developed a decision model to assess the cost-effectiveness of the addition of tranexamic acid to usual care for treatment of women with post-partum haemorrhage in Nigeria and Pakistan. We used data from the WOMAN trial to inform model parameters, supplemented by estimates from the literature. We estimated costs (calculated in 2016 US$), life-years, and quality-adjusted life-years (QALYs) with and without tranexamic acid, calculated incremental cost-effectiveness ratios (ICERs), and compared these to threshold values in each country. Costs were assessed from the health-care provider perspective and discounted at 3% per year in the base case analysis. We did a series of one-way sensitivity analyses and probabilistic sensitivity analysis to assess the robustness of the results to parameter uncertainty.FindingsEarly treatment of post-partum haemorrhage with tranexamic acid generated an average gain of 0·18 QALYs at an additional cost of $37·12 per patient in Nigeria and an average gain of 0·08 QALYs at an additional cost of $6·55 per patient in Pakistan. The base case ICER results were $208 per QALY in Nigeria and $83 per QALY in Pakistan. These ICERs were below the lower bound of the cost-effectiveness threshold range in both countries. The ICERs were most sensitive to uncertainty in parameter inputs for the relative risk of death due to bleeding with tranexamic acid, the discount rate, the cost of the drug, and the baseline probability of death due to bleeding.InterpretationEarly treatment of post-partum haemorrhage with tranexamic acid is highly cost-effective in Nigeria and Pakistan, and is likely to be cost-effective in countries in sub-Saharan Africa and southern Asia with a similar baseline risk of death due to bleeding.FundingLondon School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.

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“…30 TXA has been demonstrated to show cost savings when used in multiple settings, including orthopedic procedures and trauma surgery. 6,9,10 However, there is little literature directly comparing the cost of TXA versus EACA, especially in cardiac surgery. One study of patients undergoing total joint arthroplasty compared cost of TXA versus EACA and showed a significant cost savings with TXA.…”

Section: Discussionmentioning

confidence: 99%

“…TXA has been adopted in the settings of trauma surgery, joint-replacement surgery, postpartum hemorrhage, and cardiac surgery. 2 , 5 , 6 , 7 , 8 , 9 , 10 TXA binds to plasminogen, which prevents its conversion to plasmin and its interaction with fibrin, ultimately stabilizing clot formation. 4 , 8 Also, TXA has been shown to stabilize the endothelial glycocalyx, 11 , 12 attenuate the inflammatory response in patients undergoing surgery with CPB, 13 suppress the release of a damage-associated molecular pattern, mitochondrial DNA, in burn injuries, 14 and binds to gamma-aminobutyric acid and glycine receptors in the central nervous system.…”

mentioning

confidence: 99%

Comparison of intraoperative tranexamic acid and epsilon-aminocaproic acid in cardiopulmonary bypass patients

et al. 2020

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Objective: To compare tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: Over a consecutive 2-year period, 824 adult cardiac surgery patients who received TXA during an EACA shortage were compared with 778 patients who received EACA postshortage. Patient characteristics and process and outcome variables were collected through chart review and database queries. This retrospective analysis used inverse probability of treatment weighting to control for confounding by indication, and propensity scores were calculated using a logistic regression model. Results: In adjusted models, overall transfusion rates for the TXA cohort (odds ratio [OR], 0.94; 95% confidence interval [95% CI], 0.81-1.10) and administration of platelets (OR, 1.04; 95% CI, 0.85-1.27), red blood cells (OR, 0.93; 95% CI, 0.80-1.09), fresh frozen plasma (OR, 1.00; 95% CI, 0.79-1.25), and cryoprecipitate (OR, 1.08; 95% CI, 0.71-1.64) were equivalent to the EACA cohort. In addition, there was no statistical difference with respect to stroke, seizure, mortality, reoperation for bleeding, chest tube drainage, and acute kidney injury. Patients who received TXA had shorter ventilator times (difference in medians À1.33 hours [95% CI, À1.86 to À0.80]) and lower postsurgical charges (difference of medians À$2913 [95% CI, À5147 to À679]). Conclusions: Substituting TXA for EACA during cardiac surgery with cardiopulmonary bypass did not change transfusion rate or amount, nor was there a significant difference in chest tube drainage. Patients who received TXA had a statistically significant but not clinically significant lower postoperative ventilator times and charges without an increase in mortality, stroke, reoperation for bleeding, acute kidney injury, or seizures. (JTCVS Open 2020;3:114-25) EACA appears to be equivalent to TXA for use as a lysine analog in CPB.

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Use of Tranexamic Acid in Trauma Patients: An Analysis of Cost-Effectiveness for Use in Brazil

Cited by 10 publications

References 28 publications

An economic evaluation of tranexamic acid to prevent postpartum haemorrhage in women with vaginal delivery: the randomised controlled TRAAP trial

An economic evaluation of tranexamic acid to prevent postpartum haemorrhage in women with vaginal delivery: the randomised controlled TRAAP trial

Tranexamic acid for treatment of women with post-partum haemorrhage in Nigeria and Pakistan: a cost-effectiveness analysis of data from the WOMAN trial

Comparison of intraoperative tranexamic acid and epsilon-aminocaproic acid in cardiopulmonary bypass patients

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