Hubble Michael W, Renkiewicz Ginny K, Schiro Sharon, Van Vleet Lee, Houston Sara
Department of Emergency Medical Science, Wake Technical Community College, Raleigh, North Carolina.
Department of Health Care Administration, Methodist University, Fayetteville, North Carolina.
Prehosp Emerg Care. 2023;27(3):366-374. doi: 10.1080/10903127.2022.2096946. Epub 2022 Jul 19.
Hemorrhage is responsible for up to 40% of all traumatic deaths. The seminal CRASH-2 trial demonstrated a reduction in overall mortality following early tranexamic acid (TXA) administration to bleeding trauma patients. Following publication of the trial results, TXA has been incorporated into many prehospital trauma protocols. However, the cost-effectiveness of widespread TXA adoption by EMS is unknown.
To estimate the cost-effectiveness of statewide implementation of a TXA protocol.
The North Carolina Trauma Registry was queried to identify potential TXA patients using the criteria of age ≥18 years, suspected hemorrhage, penetrating or blunt injury, and prehospital blood pressure <90 mmHg and heart rate >110 bpm. Using life tables adjusted for age, sex, and race, and the absolute risk reductions in mortality with early TXA administration reported in the literature, the life-years gained were calculated for each potential life saved. Implementation costs consisted of initial stocking, training, and replacement costs. Projected reduction in hospitalization costs were based on estimates reported in the literature. Economic analyses were conducted from societal and state EMS system perspectives. To assess the robustness of the model, univariate and bivariate sensitivity analyses were performed on selected input variables.
Based on the TXA inclusionary criteria, 159 patients could potentially receive TXA per year. In the base-case scenario with a projected absolute mortality reduction of 3%, an additional 4.8 lives per year in NC would be saved, with an estimated 191 total life-years gained. The statewide implementation and operation cost was $305,122 in year 1, and continued operating costs were $6,042 in years 2 and 3, yielding a cost per life saved of $63,967 in year 1 and $1,267 in years 2 and 3. The cost per life-year gained was $1,595 in year 1 and $32 in years 2 and 3. Annual hospitalization costs would potentially be reduced by $1,828,072.
Previous studies have demonstrated the clinical effectiveness of early TXA administration to patients with hemorrhage. Our modeling of the financial implications and clinical benefits of implementing a statewide TXA protocol suggests that prehospital TXA is a cost-effective treatment.
出血导致的创伤死亡占所有创伤死亡的40%。开创性的CRASH-2试验表明，早期给出血性创伤患者使用氨甲环酸（TXA）可降低总体死亡率。试验结果公布后，TXA已被纳入许多院前创伤治疗方案。然而，紧急医疗服务（EMS）广泛采用TXA的成本效益尚不清楚。
评估在全州范围内实施TXA方案的成本效益。
查询北卡罗来纳州创伤登记处，以年龄≥18岁、疑似出血、穿透性或钝性损伤、院前血压<90mmHg且心率>110次/分钟为标准，确定可能使用TXA的患者。利用根据年龄、性别和种族调整的生命表，以及文献中报道的早期使用TXA降低死亡率的绝对风险，计算每挽救一条潜在生命所获得的生命年数。实施成本包括初始库存、培训和更换成本。预计住院成本的降低基于文献报道的估计值。从社会和州EMS系统的角度进行经济分析。为评估模型的稳健性，对选定的输入变量进行单变量和双变量敏感性分析。
根据TXA纳入标准，每年有159名患者可能接受TXA治疗。在预计绝对死亡率降低3%的基础案例中，北卡罗来纳州每年可多挽救4.8条生命，估计总共可获得191个生命年。全州实施和运营成本在第1年为305,122美元，第2年和第3年的持续运营成本为6,042美元，第1年每挽救一条生命的成本为63,967美元，第2年和第3年为1,267美元。第1年每获得一个生命年的成本为1,595美元，第2年和第3年为32美元。每年的住院成本可能会降低1,828,072美元。
先前的研究已证明早期给出血患者使用TXA的临床有效性。我们对在全州范围内实施TXA方案的财务影响和临床益处进行的建模表明，院前使用TXA是一种具有成本效益的治疗方法。
