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Tranexamic acid for the prevention of postpartum hemorrhage: a cost-effectiveness analysis

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Abstract

Postpartum hemorrhage is a significant contributor to maternal mortality worldwide and in the United States. Tranexamic acid (TXA) has been shown to reduce PPH complications although it is not routinely recommended for use as prophylaxis to date. To estimate the cost-effectiveness of alternative risk-dictated strategies utilizing prophylactic tranexamic acid for the prevention of postpartum hemorrhage. We constructed a microsimulation-based Markov decision-analytic model estimating the cost-effectiveness of three alternative risk-dictated strategies for tranexamic acid prophylaxis versus the no prophylaxis in a cohort of 3.8 million pregnant women delivering in the United States. Each strategy differentially modified risk-specific hemorrhage probabilities by preliminary estimates of tranexamic acid’s prophylactic efficacy. Outcome measures included incremental costs, quality-adjusted life-years, and outcomes averted. Costs and benefits were considered from the healthcare system and societal perspectives over a lifetime time horizon. All intervention strategies were dominant versus no prophylaxis, implying that they were simultaneously more effective and cost-saving. Prophylaxing delivering women irrespective of hemorrhage risk produced the most favorable results overall, with estimated cost savings greater than $690 million and up to 149,505 PPH cases, 2,933 hysterectomies, and 70 maternal deaths averted, per annual cohort. Threshold analysis suggested that tranexamic acid is likely to be cost-saving for health systems at costs below $190 per gram. Our findings suggest that routine prophylaxis with tranexamic acid would likely result in substantial cost-savings and reductions in adverse maternal outcomes in this context. This study is a cost-effectiveness analysis demonstrating cost-savings and reduction in adverse maternal outcomes with routine tranexamic acid as prophylaxis for post-partum hemorrhage.

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Datasets are available through the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank Cynthia Tschampl and Donald Shepard from Brandeis University, Shayiq Ahmadzia from INOVA Loudon Hospital, and Ethan Dazelle from the United States Department of Labor for their aid in manuscript review and revision. No compensation was provided for these contributions

Funding

This study was funded through a National Heart, Lung, and Blood Institute grant (K23HL141640).

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Authors and Affiliations

  1. The George Washington University School of Medicine & Health Sciences, Washington, DC, USA

    Wayde D. H. Dazelle, Megan K. Ebner & Savita N. Potarazu

  2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC, 20037, USA

    Jamil Kazma & Homa K. Ahmadzia

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  1. Wayde D. H. Dazelle
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  2. Megan K. Ebner
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  3. Jamil Kazma
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Contributions

WD: Conceptualization, methodology, investigation, formal analysis, data curation, software, writing – original draft. ME: Investigation, resources, writing – original draft. JK: Conceptualization, supervision, writing – review and editing. SP: Review and editing. HA: Conceptualization, supervision, writing – review and editing.

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Correspondence to Homa K. Ahmadzia.

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Dazelle, W.D.H., Ebner, M.K., Kazma, J. et al. Tranexamic acid for the prevention of postpartum hemorrhage: a cost-effectiveness analysis. J Thromb Thrombolysis 56, 128–136 (2023). https://doi.org/10.1007/s11239-023-02814-w

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  • DOI: https://doi.org/10.1007/s11239-023-02814-w

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