Tranexamic acid for the prevention of postpartum hemorrhage: a cost-effectiveness analysis

Abstract

Objectives: To estimate the cost-effectiveness of alternative risk-dictated strategies utilizing prophylactic tranexamic acid (TXA) for the prevention of postpartum hemorrhage. Design: Cost-utility analysis using a Markov decision-analytic model. Setting: All US labor and delivery units. Population: A cohort of 3.8 million women delivering in the US. Methods: We constructed a microsimulation-based Markov decision-analytic model estimating the lifetime costs and benefits of three alternative risk-dictated strategies for TXA prophylaxis versus the status quo (no TXA). Each strategy differentially modified risk-specific hemorrhage probabilities by preliminary estimates of TXA’s prophylactic efficacy. Costs and benefits were considered from the healthcare system and societal perspectives. Main outcome measures: Incremental costs, quality-adjusted life-years (QALYs), and adverse maternal outcomes averted. Results: All TXA strategies were dominant versus the status quo, implying that they were more effective while also being cost-saving. Providing TXA to all delivering women irrespective of hemorrhage risk assignment produced the most favorable results overall, with estimated cost savings greater than $670 million and approximately 149,505 hemorrhage cases, 2,933 hysterectomies, and 70 maternal deaths averted, per annual cohort. Threshold analysis suggested that TXA is likely to be cost-saving for health systems at costs below $184 per gram. Conclusions: Our findings suggest that routine prophylaxis with TXA would likely result in substantial cost-savings and reductions in adverse maternal outcomes in this context. The integrity of this conclusion is maintained across all risk-dictated strategies, even when the cost of TXA is significantly higher than what is supported in the literature.

Oral versus intravenous iron for anemia in pregnancy: a cost-effectiveness analysis

“…The cost of treating PPH was adapted from a recent publication by Dazelle et al 24 The cost of PPD in the primary analysis was estimated as the average excess medical costs per patient with PPD accrued within the first year post-delivery. [25][26][27] We estimated the costs of blood transfusions as the product of cost per unit, transfusion frequency, and units transfused plus the product of average transfusion reaction cost and frequency.…”

“…15,[56][57][58] To account for the indirect costs to society of maternal morbidity and mortality, we estimate these values as functions of productivity loss, following the methodology reported by Dazelle et al that accounts for the economic value of paid and unpaid labor by women. 24 This article is protected by copyright. All rights reserved.…”