The cost‐effectiveness of tranexamic acid for treatment of postpartum hemorrhage: A systematic review

Aziz, Samia; Rossiter, Shania; Homer, Caroline; Wilson, Alyce N.; Comrie-Thomson, Liz; Scott, Nick; Vogel, Joshua P.

doi:10.1002/ijgo.13654

Cited by 9 publications

(1 citation statement)

References 23 publications

(141 reference statements)

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“…Low-income countries comprised Burkina Faso, the Democratic Republic of Congo, Ethiopia, Sudan, and Uganda. In their 2021 systematic review of the cost-effectiveness of TXA for PPH treatment, Aziz identified four studies from three countries [ 10 ]. They concluded that TXA is cost-effective in Nigeria and Pakistan but not in the United States unless the probability of death due to PPH is high enough.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid for Postpartum Hemorrhage Treatment in Low-Resource Settings: A Rapid Scoping Review

Tran

Bar-Zeev

Schulte-Hillen³

et al. 2022

IJERPH

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Tranexamic acid (TXA) effectively reduces bleeding in women with postpartum hemorrhage (PPH) in hospital settings. To guide policies and practices, this rapid scoping review undertaken by two reviewers aimed to examine how TXA is utilized in lower-level maternity care settings in low-resource settings. Articles were searched in EMBASE, MEDLINE, Emcare, the Maternity and Infant Care Database, the Joanna Briggs Institute Evidence-Based Practice Database, and the Cochrane Library from January 2011 to September 2021. We included non-randomized and randomized research looking at the feasibility, acceptability, and health system implications in low- and lower-middle-income countries. Relevant information was retrieved using pre-tested forms. Findings were descriptively synthesized. Out of 129 identified citations, 23 records were eligible for inclusion, including 20 TXA effectiveness studies, two economic evaluations, and one mortality modeling. Except for the latter, all the studies were conducted in lower-middle-income countries and most occurred in tertiary referral hospitals. When compared to placebo or other medications, TXA was found effective in both treating and preventing PPH during vaginal and cesarean delivery. If made available in home and clinic settings, it can reduce PPH-related mortality. TXA could be cost-effective when used with non-surgical interventions to treat refractory PPH. Capacity building of service providers appears to need time-intensive training and supportive monitoring. No studies were exploring TXA acceptability from the standpoint of providers, as well as the implications for health governance and information systems. There is a scarcity of information on how to prepare the health system and services to incorporate TXA in lower-level maternity care facilities in low-resource settings. Implementation research is critically needed to assist practitioners and decision-makers in establishing a TXA-inclusive PPH treatment package to reduce PPH-related death and disability.

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Section: Introductionmentioning

confidence: 99%