cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the crash-2 trial管理的成本效益分析氨甲环酸出血创伤患者使用crash-2证据审判.pdfVIP

Cost-Effectiveness Analysis of Administering Tranexamic Acid to Bleeding Trauma Patients Using Evidence from the CRASH-2 Trial 1 1 2 2 2 Carla Guerriero *, John Cairns , Pablo Perel , Haleema Shakur , Ian Roberts , on behalf of CRASH 2 trial collaborators 1 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom, 2 Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom 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. 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