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

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 128; no. 1; pp. 114 - 120
• Main Authors: Durand‐Zaleski, I, Deneux‐Tharaux, C, Seco, A, Malki, M, Frenkiel, J, Sentilhes, L
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2021
• Subjects: Adult; Antifibrinolytic agents; Antifibrinolytic Agents - economics; Antifibrinolytic Agents - therapeutic use; Bleeding; Childbirth & labor; Cost; Cost-Benefit Analysis; Costs; cost‐effectiveness; Delivery, Obstetric; Drug therapy; Female; France; Health care expenditures; Hemorrhage; Hospitals, University; Humans; Postpartum; postpartum haemorrhage; Postpartum Hemorrhage - prevention & control; Postpartum period; Pregnancy; Prenatal Care; Prevention; Sensitivity analysis; tranexamic acid; Tranexamic Acid - economics; Tranexamic Acid - therapeutic use; Vagina; Womens health; France; postpartum haemorrhage; cost-effectiveness; Cost; prevention; tranexamic acid
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.16456

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 ± 388 and €2288 ± 409 per woman, respectively (P = 0.79). In women with postpartum haemorrhage of at least 500 ml (trial primary endpoint), costs were €2359 ± 354 and €2409 ± 525 (P = 0.14); for provider‐assessed clinically significant postpartum haemorrhage and postpartum haemorrhage of at least 1000 ml, costs were respectively €2316 ± 347 versus €2381 ± 521 (P = 0.22) and €2321 ± 318 versus €2411 ± 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. Tweetable Tranexamic acid at vaginal delivery reduces both costs and bleeding events 3 times out of 4. Tweetable Tranexamic acid at vaginal delivery reduces both costs and bleeding events 3 times out of 4.