• I Durand-Zaleski, C Deneux-Tharaux, A Seco, M Malki, J Frenkiel, L Sentilhes, and for TRAAP study group.
• AP-HP Health Economics Research Unit, Hotel Dieu Hospital, Paris, France.
• BJOG. 2021 Jan 1; 128 (1): 114-120.

ObjectiveTo estimate the cost-effectiveness of tranexamic acid (TXA) use to prevent postpartum haemorrhage.DesignA trial-based economic evaluation.SettingFifteen French university maternity hospitals.PopulationWomen 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 MeasuresWe 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.ResultsAmong 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.ConclusionsOur findings support the use of TXA, as both bleeding events and cost may be reduced three out of four times.Tweetable AbstractTranexamic acid at vaginal delivery reduces both costs and bleeding events 3 times out of 4.© 2020 John Wiley & Sons Ltd.

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