Routine Use of Tranexamic Acid in Postpartum Hemorrhage

INTRODUCTION: Postpartum hemorrhage (PPH) is a leading cause of pregnancy-related morbidity and mortality worldwide. Recent data has demonstrated that tranexamic acid (TXA), an antifibrinolytic agent, reduces death due to bleeding when used as a treatment for PPH. Our objective was to determine whether the routine use of TXA in the setting of PPH is cost-effective. METHODS: A decision analytic model was designed using TreeAge software in order to compare the outcomes and costs of TXA use in the treatment of PPH. RESULTS: Administration of TXA to a theoretical cohort of 100,000 women receiving usual care for PPH would prevent 403 maternal deaths due to hemorrhage and 457 laparotomies to control bleeding. This improvement in outcomes would result in an increase in 11,000 QALYs and a cost savings of $596 million. Furthermore, if TXA were administered early (within 3 hours) to the same theoretical cohort, 568 maternal deaths due to hemorrhage and 635 laparotomies would be prevented. This amounts to an increase in 16,000 QALYs and a cost savings of $842 million. Sensitivity analysis showed that the administration of TXA was the dominant strategy (lower costs, better outcomes) at all probabilities of maternal death due to hemorrhage. When the cost of TXA was varied, TXA use remained dominant up to a cost of $6,000 per administration and was cost-effective up to $16,555 (assumed cost = $50.40 per administration). CONCLUSION: Early administration of TXA is a cost-effective strategy for reducing maternal morbidity and mortality due to PPH.