Tuesday, October 25, 2011: 10:15 AM
Grand Ballroom CD (Hyatt Regency Chicago)
(ESP) Applied Health Economics, Services, and Policy Research

Candidate for the Lee B. Lusted Student Prize Competition

Marķa Clara Mendoza Arango, MD1, Shihchen Kuo, RPh, MSCP1, Carlos H. Morales Uribe, MD, MS2, Juan C. Puyana, MD1 and Kenneth J. Smith, MD, MS1, (1)University of Pittsburgh, Pittsburgh, PA, (2)University of Antioquia, Medellin, Colombia

Purpose: Tranexamic acid (TXA) is an antifibrinolytic agent that decreased mortality in trauma patients with increased bleeding risk. We sought to determine cost effectiveness of general implementation of this pharmacological strategy in trauma patients with significant bleeding.

Methods: We developed a decision-analytical model to compare implementation of TXA infusion with no TXA infusion in trauma patients, modeling the clinical and economic consequences of these strategies in patients with significant bleeding risk early in their post-trauma care. Events included in the model were death, bleeding, vascular occlusion, drug-related adverse events and post-injury health status. Intervention costs fluctuations were modeled from the least expensive generic drug to the most expensive therapeutic brand; other costs were assumed to be equal between strategies, potentially biasing against TXA. Probabilities mainly came from the CRASH-2 study, a large placebo controlled trial of the effects of early administration of a short course of TXA on death, vascular occlusive events, and the receipt of blood transfusion. This trial recruited 20,211 patients from 274 hospitals in 40 countries. Health state utilities were obtained from medical literature, reflecting the effect of possible adverse events due to antifibrinolytic treatment. The time horizon for the model was one year. Sensitivity analyses were performed to identify variables whose variation impacted base case model results.  

Results: In the base case analysis, TXA gained 0.0381 more quality-adjusted life-years (QALYs) at an added cost of $160, or $4,199/QALY. In sensitivity analyses, TXA cost $2,205/QALY when drug costs were at the lower limit ($84, base case $160) and cost $32,018/QALY at the upper limit ($1,220). Results were also sensitive to variation of adverse events risk related to TXA, with the incremental cost-effectiveness ratio increasing to $65,570/QALY when this risk was fixed at 80% (base case 5%). 

Conclusions: Our results favor TXA therapy in trauma patients over no TXA. The economic benefit of TXA is substantial in an analysis biasing against its use. Based on favorable clinical trial and economic analysis data, adoption of TXA in trauma treatment protocols should be recommended. *Funded by FIC NIH grant D43 TW007560 01