title: Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial.
abstract: 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Early administration of TXA to bleeding trauma patients is likely to be highly cost effective in low, middle and high income settings.
  
  
  BACKGROUND
  This paper uses data collected by the CRASH 2 trial: Controlled-Trials.com ISRCTN86750102, Clinicaltrials.govNCT00375258 and South African Clinical Trial Register DOH-27-0607-1919.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. Carla.guerriero@lshtm.ac.uk
authors.forename: Carla
authors.initials: C
authors.lastname: Guerriero
authors.forename: John
authors.initials: J
authors.lastname: Cairns
authors.forename: Pablo
authors.initials: P
authors.lastname: Perel
authors.forename: Haleema
authors.initials: H
authors.lastname: Shakur
authors.forename: Ian
authors.initials: I
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D000328:Adult; D000933:Antifibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D014943:Global Health; D006470:Hemorrhage / Q000188:drug therapy*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007194:India; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D011336:Probability; D012306:Risk; D013636:Tanzania; D014148:Tranexamic Acid / Q000191:economics* / Q000627:therapeutic use*; D006113:United Kingdom
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid