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Ragusa A, Ficarola F, Ferrari A, Spirito N, Ardovino M, Giraldi D, Stuzziero E, Rinaldo D, Procaccianti R, Larciprete G, De Luca C, D'Avino S, Principi G, Angioli R, Svelato A. Tranexamic acid versus oxytocin prophylaxis in reducing post-partum blood loss, in low-risk pregnant women: TRANOXY STUDY, a phase III randomized clinical trial. EClinicalMedicine 2024; 73:102665. [PMID: 38873634 PMCID: PMC11169955 DOI: 10.1016/j.eclinm.2024.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background To assess the equivalence of tranexamic acid (TRAN) versus synthetic oxytocin (OXY) in reducing post-partum blood loss, in full-term patients (37-42 weeks), at low risk of post-partum hemorrhage, with vaginal childbirth. Methods Phase III, randomized (1:1), open-label, longitudinal, multi-center, prospective clinical trial (Prot. n 63209, ClinicalTrials.gov Identifier: NCT02775773). From January 7, 2020, to June 30, 2023, a total of 256 women were enrolled at two general urban community hospitals in Italy, serving a multi-ethnic patient population with National Health Insurance. The primary outcome was to explore a potential equivalence between the two treatments (OXY and TRAN) in preventing total blood loss. Therefore, we randomized 231 women into two groups: Group A (OXY), 127 women who were administered 10UI intramuscularly within 5 min from childbirth; Group B (TRAN), 104 women to whom 1-g slow intravenous infusion was administered within 5 min from childbirth. Findings At the time of delivery, mean blood loss for OXY group versus TRAN group was 269.12 mL versus 263.88 mL, respectively, with equivalence between the two groups. Similarly, there was equivalence in total blood loss between the OXY and the TRAN group (397.66 mL versus 405.64 mL, respectively. No statistical differences between Hb levels at admission and discharge in the two groups were reported. No difference was found in terms of additional uterotonic and surgical therapies between the two groups of patients. Neither group showed thrombotic complications at check-up performed after 7 days or after a questionnaire regarding adverse effects, subjected after 40 days. Interpretation The study shows the equivalence of tranexamic acid versus synthetic oxytocin in post-partum blood loss prophylaxis in term patients at low risk of PPH with vaginal childbirth. The safety profiles of OXY and TRAN were similar. Funding None.
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Affiliation(s)
- Antonio Ragusa
- Department of Obstetrics and Gynecology, Maggiore Hospital Carlo Alberto Pizzardi Bologna, Italy
| | - Fernando Ficarola
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Unit of Gynecology, Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Amerigo Ferrari
- Institute of Management, MeS (Management and Health) Laboratory, Sant’Anna School of Advanced Studies, Pisa, Italy
| | - Nicoletta Spirito
- Department of Obstetrics and Gynecology, Ospedale Apuane, Massa Carrara, Italy
| | - Mario Ardovino
- Department of Obstetrics and Gynecology, Ospedale S.G. Moscati, Avellino, Italy
| | - Domenico Giraldi
- Department of Obstetrics and Gynecology, Ospedale S.G. Moscati, Avellino, Italy
| | - Elisario Stuzziero
- Department of Obstetrics and Gynecology, Ospedale S.G. Moscati, Avellino, Italy
| | - Denise Rinaldo
- Department of Obstetrics and Gynecology, ASST Bergamo Est, Bolognini Hospital, Seriate, Italy
| | - Roberto Procaccianti
- Department of Gynecology and Obstetrics, Fondazione Istituto San Raffaele G Giglio, Cefalù, Italy
| | - Giovanni Larciprete
- Department of Obstetrics and Gynecology, Fatebenefratelli Gemelli Hospital, Isola Tiberina, Roma, Italy
| | - Caterina De Luca
- Department of Obstetrics and Gynecology, Fatebenefratelli Gemelli Hospital, Isola Tiberina, Roma, Italy
| | - Sara D'Avino
- Department of Obstetrics and Gynecology, Fatebenefratelli Gemelli Hospital, Isola Tiberina, Roma, Italy
| | - Giulia Principi
- Department of Obstetrics and Gynecology, University of Messina, Messina, Italy
| | - Roberto Angioli
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alessandro Svelato
- Department of Obstetrics and Gynecology, Fatebenefratelli Gemelli Hospital, Isola Tiberina, Roma, Italy
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Meza Monge K, Domene SS, Diaz Mendoza DL, Vidal-Gallardo A, Alfaro Llique AM, Rodriguez M, Premchandra P, Anwar Pandya S, Arruarana VS, Aleman Paredes K, Calderon Martinez E. Effectiveness of Tranexamic Acid in Trauma Patients: A Systematic Review. Cureus 2024; 16:e52111. [PMID: 38213943 PMCID: PMC10783610 DOI: 10.7759/cureus.52111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 01/13/2024] Open
Abstract
Tranexamic acid (TXA), a fibrinolytic agent, effectively inhibits plasminogen activation, thereby reducing fibrinolysis and hemorrhage. This study focused on its application in trauma patients undergoing emergency surgery, a critical area due to trauma's significant role in mortality. Our investigation involved a meticulous screening of randomized controlled trials from databases including Scopus, PubMed, Web of Science, and Cochrane. The findings indicate that TXA intervention is promising in enhancing outcomes for trauma patients. However, the drug's effectiveness may vary based on the specific nature of the medical condition. In summary, robust evidence suggests that TXA can diminish blood loss, lower transfusion rates, reduce complications, and improve hemoglobin and hematocrit levels in surgical patients. Consequently, TXA should be considered a crucial medication, readily available to mitigate morbidity and mortality in surgical settings. Future research should explore factors influencing TXA's effectiveness in traumatic brain injury cases and across a broad spectrum of surgical scenarios in diverse patient populations. This would further guide clinicians in refining and optimizing the use of TXA.
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Affiliation(s)
- Kenneth Meza Monge
- General Practice, Universidad Nacional Autónoma de Mexico, Mexico City, MEX
| | - Sabrina S Domene
- General Practice, Universidad Nacional de Mar del Plata, Mar del Plata, ARG
| | | | | | | | | | - Pooja Premchandra
- General Practice, American International Medical University, Gros Islet, LCA
| | | | - Victor S Arruarana
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
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OLIVEIRA JOSÉALBERTOALVES, BRITO GABRIELLACRISTINACOELHODE, BEZERRA FRANCISCAMAGNAPRADO, CARVALHO NETO CARLOSALFREDODE, ALENCAR NETO JONATASBRITODE, IBIAPINA ROBERTOCÉSARPONTES. THE USE OF ANTIFIBRINOLYTICS IN HIP TRAUMA SURGERY IN A PUBLIC HEALTH SYSTEM: A PROSPECTIVE STUDY. ACTA ORTOPEDICA BRASILEIRA 2021; 29:304-307. [PMID: 34849094 PMCID: PMC8601384 DOI: 10.1590/1413-785220212906244502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/09/2020] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the use of tranexamic acid (TXA) and ε-aminocaproic acid (EACA) in reducing blood loss in hip and proximal femur trauma surgery. Methods: Prospective study with 49 patients surgically treated in a trauma hospital between Nov/2015 and Feb/2017. The patients were divided in two groups: TXA (n = 24) and EACA (n = 25). The comparison was made according to gender, age at the time of surgery, ASA, fracture and surgery type, estimated blood loss during surgical approach, hemoglobin and hematocrit levels pre and post-operative, and pharmacological cost. The data was processed using SPSS 22.0 with significance level of p < 0,05. Results: No significant difference was found in the variables age, gender, ASA and estimated blood loss during surgical approach. No patient needed blood transfusion. When evaluated post-operatively, the hemoglobin and hematocrit values decrease had no significant difference between the antifibrinolytics (p > 0.05). When analyzing total cost for both pharmacological agents, higher cost was observed in EACA than in TXA (US$ 16.09 - US$ 2.73), resulting in a US$ 13.36 addition per patient. Conclusion: Antifibrinolytic use was efficient on lowering the total blood loss, without the need of blood transfusion. Level of evidence II, Prospective Comparative Study.
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Lima LPDST, Santos PRS, Martins HJ, Rodrigues DADS, Silva LM, Libardi MBO, Azevedo NAM. Use of Tranexamic Acid in Traumatic Resuscitation in a Prehospital Setting: A Case Report. Air Med J 2021; 40:359-362. [PMID: 34535245 DOI: 10.1016/j.amj.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/28/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
This study describes the use of tranexamic acid associated with other measures in the initial approach to contain bleeding in a situation of hemorrhagic shock in a trauma patient. The case describes the care of a young man with multiple thorax punctures by a melee weapon, quickly progressing to a condition of severe shock, in addition to the action of a helicopter emergency medical team supporting the patient's transportation from a low-complexity emergency care unit to a specialized unit.
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Affiliation(s)
- Lilyan Paula de Sousa Teixeira Lima
- Mobile Emergency Care Service, Serviço de Atendimento Móvel de Urgência, Brasília, Brazil; Helicopter Emergency Medical Services, Military Firefighters Corps of the Federal District, Brasília, Brazil.
| | - Paulo Regis Souza Santos
- Mobile Emergency Care Service, Serviço de Atendimento Móvel de Urgência, Brasília, Brazil; Helicopter Emergency Medical Services, Military Firefighters Corps of the Federal District, Brasília, Brazil.
| | - Herberth Jessie Martins
- Mobile Emergency Care Service, Serviço de Atendimento Móvel de Urgência, Brasília, Brazil; Helicopter Emergency Medical Services, Military Firefighters Corps of the Federal District, Brasília, Brazil.
| | - Daniel Augusto de Souza Rodrigues
- Mobile Emergency Care Service, Serviço de Atendimento Móvel de Urgência, Brasília, Brazil; Helicopter Emergency Medical Services, Military Firefighters Corps of the Federal District, Brasília, Brazil.
| | - Larissa Michetti Silva
- Mobile Emergency Care Service, Serviço de Atendimento Móvel de Urgência, Brasília, Brazil; Trauma Center of the Federal District, Brasília, Brazil.
| | - Mônica Beatriz Ortolan Libardi
- Mobile Emergency Care Service, Serviço de Atendimento Móvel de Urgência, Brasília, Brazil; Helicopter Emergency Medical Services, Military Firefighters Corps of the Federal District, Brasília, Brazil.
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Durand-Zaleski I, Deneux-Tharaux C, Seco A, Malki M, Frenkiel J, Sentilhes L. An economic evaluation of tranexamic acid to prevent postpartum haemorrhage in women with vaginal delivery: the randomised controlled TRAAP trial. BJOG 2020; 128:114-120. [PMID: 32770781 DOI: 10.1111/1471-0528.16456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
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 ABSTRACT Tranexamic acid at vaginal delivery reduces both costs and bleeding events 3 times out of 4.
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Affiliation(s)
- I Durand-Zaleski
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, Paris, France.,INSERM UMR 1153 CRESS, Clinical Epidemiology(Methods) & Obstetrical, Perinatal and Pediatric Epidemiology (Epopé) Research Team, Paris Descartes University, Paris, France
| | - C Deneux-Tharaux
- INSERM UMR 1153 CRESS, Clinical Epidemiology(Methods) & Obstetrical, Perinatal and Pediatric Epidemiology (Epopé) Research Team, Paris Descartes University, Paris, France
| | - A Seco
- INSERM UMR 1153 CRESS, Clinical Epidemiology(Methods) & Obstetrical, Perinatal and Pediatric Epidemiology (Epopé) Research Team, Paris Descartes University, Paris, France.,APHP Paris Centre Clinical Research Unit, Paris, France
| | - M Malki
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, Paris, France
| | - J Frenkiel
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, Paris, France
| | - L Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
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Comparison of intraoperative tranexamic acid and epsilon-aminocaproic acid in cardiopulmonary bypass patients. JTCVS OPEN 2020; 3:114-125. [PMID: 36003884 PMCID: PMC9390169 DOI: 10.1016/j.xjon.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
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Werner K, Risko N, Burkholder T, Munge K, Wallis L, Reynolds T. Cost-effectiveness of emergency care interventions in low and middle-income countries: a systematic review. Bull World Health Organ 2020; 98:341-352. [PMID: 32514199 PMCID: PMC7265944 DOI: 10.2471/blt.19.241158] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To systematically review and appraise the quality of cost-effectiveness analyses of emergency care interventions in low- and middle-income countries. METHODS Following the PRISMA guidelines, we systematically searched PubMed®, Scopus, EMBASE®, Cochrane Library and Web of Science for studies published before May 2019. Inclusion criteria were: (i) an original cost-effectiveness analysis of emergency care intervention or intervention package, and (ii) the analysis occurred in a low- and middle-income setting. To identify additional primary studies, we hand searched the reference lists of included studies. We used the Consolidated Health Economic Evaluation Reporting Standards guideline to appraise the quality of included studies. RESULTS Of the 1674 articles we identified, 35 articles met the inclusion criteria. We identified an additional four studies from the reference lists. We excluded many studies for being deemed costing assessments without an effectiveness analysis. Most included studies were single-intervention analyses. Emergency care interventions evaluated by included studies covered prehospital services, provider training, treatment interventions, emergency diagnostic tools and facilities and packages of care. The reporting quality of the studies varied. CONCLUSION We found large gaps in the evidence surrounding the cost-effectiveness of emergency care interventions in low- and middle-income settings. Given the breadth of interventions currently in practice, many interventions remain unassessed, suggesting the need for future research to aid resource allocation decisions. In particular, packages of multiple interventions and system-level changes represent a priority area for future research.
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Affiliation(s)
- Kalin Werner
- Department of Surgery, Division of Emergency Medicine, F51-62, Old Main Building, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Nicholas Risko
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, United States of America (USA)
| | - Taylor Burkholder
- Department of Emergency Medicine, University of Southern California, Los Angeles, USA
| | - Kenneth Munge
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lee Wallis
- Department of Surgery, Division of Emergency Medicine, F51-62, Old Main Building, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Teri Reynolds
- Department for Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
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Risko N, Chandra A, Burkholder TW, Wallis LA, Reynolds T, Calvello Hynes EJ, Razzak J. Advancing research on the economic value of emergency care. BMJ Glob Health 2019; 4:e001768. [PMID: 31406603 PMCID: PMC6666808 DOI: 10.1136/bmjgh-2019-001768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 01/08/2023] Open
Abstract
Emergency care and the emergency care system encompass an array of time-sensitive interventions to address acute illness and injury. Research has begun to clarify the enormous economic burden of acute disease, particularly in low-income and middle-income countries, but little is known about the cost-effectiveness of emergency care interventions and the performance of health financing mechanisms to protect populations against catastrophic health expenditures. We summarise existing knowledge on the economic value of emergency care in low resource settings, including interventions indicated to be highly cost-effective, linkages between emergency care financing and universal health coverage, and priority areas for future research.
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Affiliation(s)
- Nicholas Risko
- Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amit Chandra
- Collaborative on Enhancing Emergency Care Research in Low and Middle Income Countries, Bethesda, Maryland, USA
| | - Taylor W Burkholder
- Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Lee A Wallis
- Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Teri Reynolds
- Department for Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | | | - Junaid Razzak
- Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
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El-Menyar A, Sathian B, Asim M, Latifi R, Al-Thani H. Efficacy of prehospital administration of tranexamic acid in trauma patients: A meta-analysis of the randomized controlled trials. Am J Emerg Med 2018; 36:1079-1087. [PMID: 29573898 DOI: 10.1016/j.ajem.2018.03.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Antifibrinolytic agent tranexamic acid (TXA) has a potential clinical benefit for in-hospital patients with severe bleeding but its effectiveness in pre-hospital settings remains unclear. We conducted a systematic review and meta-analysis to evaluate whether pre-hospital administration of TXA compared to placebo improve patients' outcomes? METHODS PubMed, MEDLINE, Cochrane Library, WHO International Clinical Trials Registry Platform, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, clinicaltrials.gov and Google scholar databases were searched for a retrospective, prospective and randomized (RCT) or quasi-RCT studies that assessed the effect of prehospital administration of TXA versus placebo on the outcomes of trauma patients with significant hemorrhage. The main outcomes of interest were 24hour 30-day mortality and in-hospital thromboembolic complications. Two authors independently abstracted the data using a data collection form. Results from different studies were pooled for the analysis, when appropriate. RESULTS Out of 92 references identified through the search, two analytical studies met the inclusion criteria. The effect of TXA on 24-hour mortality had a pooled odds ratio (OR) of 0.49 (95% CI 0.28-0.85), 30-day mortality OR of 0.86 (95% CI, 0.56-1.32), and thromboembolic events OR of 0.74 (95% CI, 0.27-2.07). CONCLUSION Prehospital TXA appears to reduce early mortality in trauma patients. The pooled analysis also shows a trend toward lower 30-day mortality and reduced risk of thromboembolic events. Additional randomized controlled clinical trials are needed to determine the significance of these trends.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
| | - Brijesh Sathian
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
| | - Mohammed Asim
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA.
| | - Hassan Al-Thani
- Department of Surgery, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
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Li B, Miners A, Shakur H, Roberts I. Tranexamic acid for treatment of women with post-partum haemorrhage in Nigeria and Pakistan: a cost-effectiveness analysis of data from the WOMAN trial. Lancet Glob Health 2018; 6:e222-e228. [PMID: 29389542 PMCID: PMC5785366 DOI: 10.1016/s2214-109x(17)30467-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/16/2017] [Accepted: 11/20/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sub-Saharan Africa and southern Asia account for almost 85% of global maternal deaths from post-partum haemorrhage. Early administration of tranexamic acid, within 3 h of giving birth, was shown to reduce the risk of death due to bleeding in women with post-partum haemorrhage in the World Maternal Antifibrinolytic (WOMAN) trial. We aimed to assess the cost-effectiveness of early administration of tranexamic acid for treatment of post-partum haemorrhage. METHODS For this economic evaluation we developed a decision model to assess the cost-effectiveness of the addition of tranexamic acid to usual care for treatment of women with post-partum haemorrhage in Nigeria and Pakistan. We used data from the WOMAN trial to inform model parameters, supplemented by estimates from the literature. We estimated costs (calculated in 2016 US$), life-years, and quality-adjusted life-years (QALYs) with and without tranexamic acid, calculated incremental cost-effectiveness ratios (ICERs), and compared these to threshold values in each country. Costs were assessed from the health-care provider perspective and discounted at 3% per year in the base case analysis. We did a series of one-way sensitivity analyses and probabilistic sensitivity analysis to assess the robustness of the results to parameter uncertainty. FINDINGS Early treatment of post-partum haemorrhage with tranexamic acid generated an average gain of 0·18 QALYs at an additional cost of $37·12 per patient in Nigeria and an average gain of 0·08 QALYs at an additional cost of $6·55 per patient in Pakistan. The base case ICER results were $208 per QALY in Nigeria and $83 per QALY in Pakistan. These ICERs were below the lower bound of the cost-effectiveness threshold range in both countries. The ICERs were most sensitive to uncertainty in parameter inputs for the relative risk of death due to bleeding with tranexamic acid, the discount rate, the cost of the drug, and the baseline probability of death due to bleeding. INTERPRETATION Early treatment of post-partum haemorrhage with tranexamic acid is highly cost-effective in Nigeria and Pakistan, and is likely to be cost-effective in countries in sub-Saharan Africa and southern Asia with a similar baseline risk of death due to bleeding. FUNDING London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Bernadette Li
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Haleema Shakur
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
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