748: Tranexamic acid in the treatment of post-partum hemorrhage in the united states: a cost-effectiveness analysis

Abstract

The WOMAN trial demonstrated that tranexamic acid (TXA) reduces hemorrhage-related mortality and laparotomies, especially when given in the first 3 hours after birth. The World Health Organization has thus recommended early use of TXA in the treatment of post-partum hemorrhage (PPH). We aim to demonstrate the cost -effectiveness of routine TXA administration in the treatment of PPH in the US. We constructed a decision tree comparing 3 strategies in women with PPH from a health care institution perspective: no TXA, TXA given at any time, and TXA given within 3 hours of delivery. We incorporated probabilities and costs based on available data in the model of a population of women with PPH in the US. We assumed the risk reduction of TXA for death and laparotomy would be similar to the WOMAN trial. Primary outcomes included incremental cost, PPH-related deaths avoided, and laparotomies avoided under each strategy. As we anticipated that the risk reduction with TXA in the US may be lower than in the WOMAN trial, we performed one-way and two- way sensitivity analyses to explore the parameter uncertainty across a wide range of data-supported estimates. Probabilistic sensitivity analyses with Monte Carlo simulation were performed. TXA strategies were dominant (more effective and cost-saving) compared to no routine TXA for patients with PPH in the US (Table). One-way threshold analyses showed that TXA is cost-saving as long as any of the following criteria are met: the risk reduction of death with TXA is at least 5%, the risk reduction of laparotomy with TXA is at least 7%, or the cost of TXA is no greater than $194. A two-way sensitivity analysis of the risk of PPH-related death and the risk reduction of death due to TXA confirmed that TXA is cost-saving across a wide range of plausible estimates (Figure). Probabilistic sensitivity analysis with 10,000 Monte Carlo simulations demonstrated that the TXA strategies are cost- saving in >99.9% of simulations, and that TXA within 3 hours is the cost-saving approach 86.4% of the time. The annual cost savings expected from routine use of TXA for treatment of PPH in the US is $18.8 million (Table). In the US, a policy of routine TXA treatment during PPH is effective, safe, and cost-saving, despite the upfront cost of routine TXA use. This conclusion is true across a wide range of probability and cost assumptions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)