Economic evaluation of tranexamic acid for the treatment of acute gastrointestinal bleeding: a cost-effectiveness analysis using data from the HALT-IT randomised controlled trial
Objective To perform an economic evaluation of tranexamic acid (TXA) versus no-TXA, in addition to current clinical practice, for acute gastrointestinal bleeding, using the results of the HALT-IT trial (NCT01658124), a large randomised controlled trial which included 11 937 patients.Design A cost-ef...
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e060505.full |
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| author | Ian Roberts Vipul Jairath Alec Miners Jack Williams Haleema Shakur-Still Nuha Bazeer |
| author_facet | Ian Roberts Vipul Jairath Alec Miners Jack Williams Haleema Shakur-Still Nuha Bazeer |
| author_sort | Ian Roberts |
| collection | DOAJ |
| description | Objective To perform an economic evaluation of tranexamic acid (TXA) versus no-TXA, in addition to current clinical practice, for acute gastrointestinal bleeding, using the results of the HALT-IT trial (NCT01658124), a large randomised controlled trial which included 11 937 patients.Design A cost-effectiveness modelling analysis, performed over a lifetime time horizon.Setting The analysis was performed from a UK health service perspective.Participants The model includes adults with acute gastrointestinal bleeding.Outcomes measures The model reports costs in Great British pounds in 2021 and outcomes as life years (LYs) and quality-adjusted life years (QALYs). Cost-effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs), reported as the cost per QALY gained.Methods A Markov model was developed to calculate the overall costs and health outcomes of TXA administration versus no-TXA. The model used data of the treatment effectiveness from the HALT-IT trial, which showed that TXA administration for acute gastrointestinal bleeding did not reduce all-cause mortality (risk ratio 1.03, 95% CI 0.92 to 1.16) compared with no-TXA. Data on health-related quality of life, costs and long-term mortality risks were derived from the literature. Costs and effects are discounted at 3.5% per annum.Results TXA was associated with marginally fewer LYs and QALYs, and lower costs, than treatment without TXA. The ICER associated with no-TXA was £1576 per LY gained and £2209 per QALY gained. No-TXA was 64% likely to be cost-effective at a £20 000 willingness-to-pay threshold, while TXA was 36% likely to be cost-effective.Conclusion Though inexpensive, TXA administration for patients with acute gastrointestinal bleeding is unlikely to be cost-effective. |
| format | Article |
| id | doaj-art-ca3c1cc6336e4f728251472923eb16c8 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ca3c1cc6336e4f728251472923eb16c82025-01-31T06:30:10ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-060505Economic evaluation of tranexamic acid for the treatment of acute gastrointestinal bleeding: a cost-effectiveness analysis using data from the HALT-IT randomised controlled trialIan Roberts0Vipul Jairath1Alec Miners2Jack Williams3Haleema Shakur-Still4Nuha Bazeer5Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UKDepartment of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada7 Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UKDepartment of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UKClinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKObjective To perform an economic evaluation of tranexamic acid (TXA) versus no-TXA, in addition to current clinical practice, for acute gastrointestinal bleeding, using the results of the HALT-IT trial (NCT01658124), a large randomised controlled trial which included 11 937 patients.Design A cost-effectiveness modelling analysis, performed over a lifetime time horizon.Setting The analysis was performed from a UK health service perspective.Participants The model includes adults with acute gastrointestinal bleeding.Outcomes measures The model reports costs in Great British pounds in 2021 and outcomes as life years (LYs) and quality-adjusted life years (QALYs). Cost-effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs), reported as the cost per QALY gained.Methods A Markov model was developed to calculate the overall costs and health outcomes of TXA administration versus no-TXA. The model used data of the treatment effectiveness from the HALT-IT trial, which showed that TXA administration for acute gastrointestinal bleeding did not reduce all-cause mortality (risk ratio 1.03, 95% CI 0.92 to 1.16) compared with no-TXA. Data on health-related quality of life, costs and long-term mortality risks were derived from the literature. Costs and effects are discounted at 3.5% per annum.Results TXA was associated with marginally fewer LYs and QALYs, and lower costs, than treatment without TXA. The ICER associated with no-TXA was £1576 per LY gained and £2209 per QALY gained. No-TXA was 64% likely to be cost-effective at a £20 000 willingness-to-pay threshold, while TXA was 36% likely to be cost-effective.Conclusion Though inexpensive, TXA administration for patients with acute gastrointestinal bleeding is unlikely to be cost-effective.https://bmjopen.bmj.com/content/12/7/e060505.full |
| spellingShingle | Ian Roberts Vipul Jairath Alec Miners Jack Williams Haleema Shakur-Still Nuha Bazeer Economic evaluation of tranexamic acid for the treatment of acute gastrointestinal bleeding: a cost-effectiveness analysis using data from the HALT-IT randomised controlled trial BMJ Open |
| title | Economic evaluation of tranexamic acid for the treatment of acute gastrointestinal bleeding: a cost-effectiveness analysis using data from the HALT-IT randomised controlled trial |
| title_full | Economic evaluation of tranexamic acid for the treatment of acute gastrointestinal bleeding: a cost-effectiveness analysis using data from the HALT-IT randomised controlled trial |
| title_fullStr | Economic evaluation of tranexamic acid for the treatment of acute gastrointestinal bleeding: a cost-effectiveness analysis using data from the HALT-IT randomised controlled trial |
| title_full_unstemmed | Economic evaluation of tranexamic acid for the treatment of acute gastrointestinal bleeding: a cost-effectiveness analysis using data from the HALT-IT randomised controlled trial |
| title_short | Economic evaluation of tranexamic acid for the treatment of acute gastrointestinal bleeding: a cost-effectiveness analysis using data from the HALT-IT randomised controlled trial |
| title_sort | economic evaluation of tranexamic acid for the treatment of acute gastrointestinal bleeding a cost effectiveness analysis using data from the halt it randomised controlled trial |
| url | https://bmjopen.bmj.com/content/12/7/e060505.full |
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