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Background: Prophylactic administration of tranexamic acid is associated with a reduction of blood loss after Caesarean delivery, but cost-effectiveness for this indication has not been assessed.

Methods: We used data from the TRAAP2 trial, a multicentre, double-blinded, RCT aimed at estimating the efficacy of tranexamic acid for preventing postpartum haemorrhage among women undergoing Caesarean delivery. Women recruited at 27 French maternity hospitals from 2018 to 2020 were enrolled before the procedure if they had a Caesarean delivery before or during labour at 34 or more weeks of gestation. The main outcomes were the cost of hospital stay for delivery and the incremental cost per delivery without complication within 90 days after delivery with tranexamic acid compared with placebo. Differences in costs and the incremental net monetary benefit (INMB) were estimated using linear regression models, and the cost-effectiveness probability of tranexamic acid compared with placebo was estimated through the parametric distribution of the INMB.

Results: The proportion of women without complications at day 90 was 70.7% in the tranexamic acid group and 66.0% in the placebo group. Mean total costs until occurrence of a complication of interest were [Euro sign]3321 in the tranexamic acid group and [Euro sign]3260 in the placebo group, resulting in a difference between the two groups of 7.2% and [Euro sign]55 after multiple imputation. The adjusted incremental cost-effectiveness ratio was [Euro sign]762 per additional Caesarean delivery without a complication at 90 days after delivery. At a cost-effectiveness threshold of [Euro sign]10,000, the cost-effectiveness probability of tranexamic acid compared with placebo was 99.9%, varying from 5.8% to 100.0% for thresholds from [Euro sign]0 to [Euro sign]10,000 per additional delivery without a complication at day 90.

Conclusion: Tranexamic acid for the prevention of blood loss is cost-effective in reducing complications after Caesarean delivery at day 90 postpartum. However, the effect size (in cost and effectiveness) is very low.

Clinical trial registration: NCT03431805.

(C) 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.