Publications & Reports

The cost-effectiveness of tranexamic acid for treatment of postpartum hemorrhage: A systematic review.

Aziz S, Rossiter S, Homer CSE, Wilson AN, Comrie-Thomson L, Scott N, Vogel JP
Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.


BACKGROUND: Postpartum hemorrhage (PPH) is responsible for nearly one quarter of maternal deaths. A 2017 multicountry trial found that incorporating tranexamic acid (TXA) into the PPH management package was effective in reducing maternal death due to bleeding. OBJECTIVE: To systematically review studies assessing the cost-effectiveness of tranexamic acid for PPH treatment. SEARCH STRATEGY: Nine databases were searched using variations of keywords ‘tranexamic acid’, ‘postpartum hemorrhage’ and ‘cost effectiveness’. SELECTION CRITERIA: Eligible studies were any type of economic or effectiveness evaluation studies on tranexamic acid for treating women with PPH. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened citations and extracted data on cost effectiveness measures. Quality was assessed using the Consensus on Health Economic Criteria list. MAIN RESULTS: Four studies were included, of which two were abstracts. Three studies concluded that early administration of TXA was cost-saving or cost-effective. One abstract reported TXA was not cost-effective in the USA unless the probability of death due to hemorrhage is higher. CONCLUSION: Available evidence (four studies in three countries) suggests that this life-saving intervention may be below willingness to pay thresholds (cost-effective) or cost saving. Further studies conducted in different populations and settings are needed to inform health policy decision-making to reduce PPH-associated morbidity and mortality.

Link to publisher’s web site


  • Journal: International Journal of Gynaecology and Obstetrics
  • Published: 23/02/2021
  • Volume: 155
  • Issue: 3
  • Pagination: 331-341