The cost-effectiveness of tranexamic acid for treatment of postpartum hemorrhage: A systematic review

Abstract

Background: Postpartum hemorrhage (PPH) is responsible for nearly one quarter of maternal deaths. A 2017 multicountry trial found that incorporating tranexamic acid (TXA) into the PPH management package was effective in reducing maternal death due to bleeding. Objective: To systematically review studies assessing the cost-effectiveness of tranexamic acid for PPH treatment. Search strategy: Nine databases were searched using variations of keywords ‘tranexamic acid’, ‘postpartum hemorrhage’ and ‘cost effectiveness’. Selection criteria: Eligible studies were any type of economic or effectiveness evaluation studies on tranexamic acid for treating women with PPH. Data collection and analysis: Two reviewers independently screened citations and extracted data on cost effectiveness measures. Quality was assessed using the Consensus on Health Economic Criteria list. Main results: Four studies were included, of which two were abstracts. Three studies concluded that early administration of TXA was cost-saving or cost-effective. One abstract reported TXA was not cost-effective in the USA unless the probability of death due to hemorrhage is higher. Conclusion: Available evidence (four studies in three countries) suggests that this life-saving intervention may be below willingness to pay thresholds (cost-effective) or cost saving. Further studies conducted in different populations and settings are needed to inform health policy decision-making to reduce PPH-associated morbidity and mortality.