Would routine use of tranexamic acid for PPH be cost-effective in the United States?
Yes. A decision-tree analysis incorporated US-specific hemorrhage-related cost and probability data with tranexamic acid (TXA) outcome data from the international WOMAN trial. The study results indicate that routine use of TXA for postpartum hemorrhage (PPH) in the United States would be cost saving from both the health system and societal perspectives, particularly when TXA is administered within 3 hours of delivery.
Study strengths and limitations
This study is novel in its critical objective to determine the cost-effectiveness of routine use of TXA for PPH in the United States. Robust modeling using Monte Carlo estimation and a variety of sensitivity analyses add reliability to the authors’ findings.
This work is limited, however, by the assumptions put into the authors’ models. For example, outcome data regarding effectiveness of TXA was taken from the WOMAN trial, which was not performed within the United States. In addition, it is difficult to quantify in dollars an event as profound as a maternal death. The authors recognize that they likely underestimate the “cost” of a maternal death, but that this underestimation would only increase the cost-effectiveness of TXA.
Finally, it is important to take into account that such economic analyses are helpful to inform institutional guidelines and hemorrhage protocols, but that patient-specific decision-making should be individualized based on the clinical scenario at hand.
Routine use of TXA for PPH, particularly within 3 hours of delivery, is likely cost-effective in the United States. Consideration should be given to including TXA in institutional hemorrhage protocols.
REBECCA F. HAMM, MD, and ADI HIRSHBERG, MD
