by Carla Guerriero, John Cairns, Pablo Perel, Haleema Shakur, Ian Roberts, on behalf of CRASH 2 trial collaborators
Objective To assess the cost effectiveness of giving tranexamic acid (TXA) to bleeding
trauma patients in low, middle and high income settings.
Methods The CRASH-2 trial showed that TXA administration reduces the risk of death in
bleeding trauma patients with a small but statistically significant increase
in non-intensive care stay. A Markov model was used to assess the cost
effectiveness of TXA in Tanzania, India and the United Kingdom (UK). The
health outcome was the number of life years gained (LYs). Two costs were
considered: the cost of administering TXA and the cost of additional days in
hospital. Cost data were obtained from hospitals, World Health Organization
(WHO) database and UK reference costs. Cost-effectiveness was measured in
international dollars ($) per LY. Both deterministic and
probabilistic sensitivity analyses were performed to test the robustness of
the results to model assumptions.
Findings Administering TXA to bleeding trauma patients within three hours of injury
saved an estimated 372, 315 and 755 LYs per 1,000 trauma patients in
Tanzania, India and the UK respectively. The cost of giving TXA to 1,000
patients was $17,483 in Tanzania, $19,550 in India and
$30,830 in the UK. The incremental cost of giving TXA versus not
giving TXA was $18,025 in Tanzania, $20,670 in India and
$48,002 in the UK. The estimated incremental cost per LY gained of
administering TXA is $48, $66 and $64 in Tanzania,
India and the UK respectively.
Conclusion Early administration of TXA to bleeding trauma patients is likely to be
highly cost effective in low, middle and high income settings.
Trial Registration This paper uses data collected by the CRASH 2 trial: Controlled-Trials.com
ISRCTN86750102, Clinicaltrials.gov
NCT00375258 and South African Clinical Trial Register
DOH-27-0607-1919.
