Cost-Effectiveness Analysis of Administering Tranexamic Acid to Bleeding Trauma Patients Using Evidence from the CRASH-2 Trial

Abstract

ObjectiveTo assess the cost effectiveness of giving tranexamic acid (TXA) to bleeding trauma patients in low, middle and high income settings.MethodsThe CRASH-2 trial showed that TXA administration reduces the risk of death in bleeding trauma patients with a small but statistically significant increase in non-intensive care stay. A Markov model was used to assess the cost effectiveness of TXA in Tanzania, India and the United Kingdom (UK). The health outcome was the number of life years gained (LYs). Two costs were considered: the cost of administering TXA and the cost of additional days in hospital. Cost data were obtained from hospitals, World Health Organization (WHO) database and UK reference costs. Cost-effectiveness was measured in international dollars ($) per LY. Both deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results to model assumptions.FindingsAdministering TXA to bleeding trauma patients within three hours of injury saved an estimated 372, 315 and 755 LYs per 1,000 trauma patients in Tanzania, India and the UK respectively. The cost of giving TXA to 1,000 patients was $17,483 in Tanzania, $19,550 in India and $30,830 in the UK. The incremental cost of giving TXA versus not giving TXA was $18,025 in Tanzania, $20,670 in India and $48,002 in the UK. The estimated incremental cost per LY gained of administering TXA is $48, $66 and $64 in Tanzania, India and the UK respectively.ConclusionEarly administration of TXA to bleeding trauma patients is likely to be highly cost effective in low, middle and high income settings.Trial RegistrationThis paper uses data collected by the CRASH 2 trial: Controlled-Trials.com ISRCTN86750102, Clinicaltrials.gov NCT00375258 and South African Clinical Trial Register DOH-27-0607-1919.

Protocol for a pilot, randomised, double-blinded, placebo-controlled trial of prophylactic use of tranexamic acid for preventing postpartum haemorrhage (TAPPH-1)

“…16 The recommended dose of TXA for the treatment of PPH is 1 g, and the cost of TXA is US$4-6/g. 17 Assuming that this intervention can produce even a modest absolute risk reduction of 1.55%, the number needed to treat (NNT) or prevent one case of PPH would be 64.5. The cost of this intervention per NNT is US$322.50.…”

Prophylactic Use of Tranexamic Acid for Postpartum Bleeding Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…[7][8][9][10] Given the pathophysiology of PPH, TXA is a promising therapy. TXA is economical 11 , has a good safety profile 12 and can be administered in multitude of health care settings where tertiary obstetrical care is not available. 13 The WOMAN trial, a large pragmatic international randomized, placebo-controlled trial modeled after the CRASH-2 trial, is in progress to determine if TXA can reduce mortality in patients with diagnosed PPH.…”

The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients

“…Cost-effectiveness analysis shows that TXA administration is highly cost-effective in HICs, MICs and LICs. 57 The public investment in the CRASH-2 trial has generated knowledge that could, and should, improve human well-being worldwide.…”