Use of tranexamic acid in trauma patients: an analysis of cost effectiveness for use in Brazil

Division of General and Trauma Surgery, Hospital de Pronto Socorro Municipal de Porto Alegre.

ABCD, Arquivos Brasileiros de Cirurgia Digestiva. 2016;29((4)):282-286.
Abstract
Introduction:: Use of tranexamic acid (TXA) in trauma has been the subject of growing interest by researchers and health professionals. However, there are still several open questions regarding its use. In some aspects medical literature is controversial. The points of disagreement among experts include questions such as: Which patients should receive TXA in trauma? Should treatment be performed in the pre-hospital environment? Is there any need for laboratory parameters before starting TXA treatment? What is the drug safety profile? The main issue on which there is still no basis in literature is: What is the indication for treatment within massive transfusion protocols? Objective:: Answer the questions proposed based on critical evaluation of the evidence gathered so far and carry out a study of cost-effectiveness of TXA use in trauma adapted to the Brazilian reality. Methods:: A literature review was performed through searching Pubmed.com, Embase and Cab Abstract by headings "tranexamic AND trauma", in all languages, yielding 426 articles. Manuscripts reporting on TXA utilization for elective procedures were excluded, remaining 79 articles. Fifty-five articles were selected, and critically evaluated in order to answer study questions. The evaluation of cost effectiveness was performed using CRASH-2 trial data and Brazilian official population data. Results:: TXA is effective and efficient, and should be administered to a wide range of patients, including those with indication evaluated in research protocols and current indication criteria for TXA should be expanded. As for the cost-effectiveness, the TXA proved to be cost-effective with an average cost of R$ 61.35 (currently US$16) per year of life saved. Conclusion:: The use of TXA in trauma setting seems to be effective, efficient and cost-effective in the various groups of polytrauma patients. Its use in massive transfusion protocols should be the subject of further investigations. Introducao:: O uso do acido tranexamico (TXA) no trauma tem sido alvo de interesse crescente por parte de pesquisadores e profissionais de saude. No entanto, seus beneficios ainda nao foram completamente definidos. Os pontos de divergencia entre especialistas incluem questoes como: quais pacientes devem receber TXA no trauma? O tratamento deve ser realizado em ambiente pre-hospitalar? Ha necessidade de exames laboratoriais para indicar o tratamento? Qual o perfil de seguranca da droga? A principal questao para a qual ainda nao existe qualquer embasamento na literatura e: qual a indicacao do tratamento dentro de protocolos de transfusao macica? Objetivo:: Responder as questoes propostas, com base em avaliacao critica da evidencia reunida ate o momento e realizar estudo de custo-efetividade do uso do TXA no trauma adaptado a realidade brasileira. Metodos:: Foi realizada revisao da literatura atraves de estrategia de busca: PubMed.com, Embase e no Cab Abstract pelos descritores "tranexamic AND trauma", em todos idiomas, resultando em 426 artigos. Foram excluidos aqueles relativos as operacoes eletivas, restando 79 artigos. Cinquenta e cinco foram selecionados e avaliados criticamente com vistas a responder as questoes em estudo. A avaliacao de custo-efetividade foi realizada utilizando dados do estudo CRASH-2 e populacionais oficiais brasileiros. Resultados:: Atraves da analise da evidencia disponivel chegou-se a conclusao de que o acido tranexamico e tratamento eficaz e efetivo, devendo ser administrado a ampla gama de pacientes, incluindo todos aqueles com indicacao ja avaliada nos protocolos de pesquisa publicados e provavelmente devam-se expandir os criterios de indicacao. Quanto a avaliacao de custo-efetividade, o TXA mostrou-se bastante custo-eficaz com gasto medio de R$ 61,35 por ano de vida salvo. Conclusao:: O uso do acido tranexamico no trauma parece ser eficaz, efetivo e custo-eficaz nos diversos grupos de pacientes politraumatizados. Seu uso em protocolos de transfusao macica ainda deve ser objeto de futuras investigacoes.
Study details
Study Design : Economic Study
Language : English, Portuguese
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine