The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
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.
J Thromb Thrombolysis. 2023 Jul;56(1):128-136. doi: 10.1007/s11239-023-02814-w. Epub 2023 May 3.
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.
产后出血是全球和美国产妇死亡的主要原因。氨甲环酸（TXA）已被证明可减少 PPH 并发症，尽管迄今为止尚未常规推荐将其用作预防措施。为了评估使用预防性氨甲环酸预防产后出血的替代风险导向策略的成本效益。我们构建了一个基于微模拟的马尔可夫决策分析模型，估计了在 380 万例在美国分娩的孕妇队列中，三种替代风险导向策略预防氨甲环酸与不预防的成本效益。每种策略通过初步估计氨甲环酸的预防功效来改变特定风险的出血概率。结果指标包括增量成本、质量调整生命年和避免的结果。成本和效益从医疗保健系统和整个生命周期的社会角度考虑。所有干预策略相对于不预防均具有优势，这意味着它们同时更有效且节省成本。无论出血风险如何，对分娩妇女进行预防性治疗总体上产生了最有利的结果，估计每年可节省超过 6.9 亿美元的成本，并可避免多达 149,505 例 PPH、2,933 例子宫切除术和 70 例产妇死亡。阈值分析表明，对于卫生系统而言，氨甲环酸的成本低于每克 190 美元时，很可能具有成本效益。我们的研究结果表明，在这种情况下，常规使用氨甲环酸预防产后出血可能会带来显著的成本节约和减少不良产妇结局。本研究是一项成本效益分析，表明常规使用氨甲环酸作为产后出血预防措施可节省成本并减少不良产妇结局。
