A cost-effectiveness and value of information analysis to inform future research of tranexamic acid for older adults experiencing mild traumatic brain injury.

Abstract

BACKGROUND:

Tranexamic acid reduces head injury deaths in patients with CT scan evidence of intracranial bleeding after mild traumatic brain injury (TBI). However, the cost-effectiveness of tranexamic acid for people with mild TBI in the pre-hospital setting, prior to CT scanning, is uncertain. A large randomised controlled trial (CRASH-4) is planned to address this issue, but the economic justification for it has not been established. The aim of the analysis was to estimate the likelihood of tranexamic acid being cost-effective given current evidence, the treatment effects required for cost-effectiveness, and the expected value of performing further research.

METHODS:

An early economic decision model compared usual care for mild TBI with and without tranexamic acid, for adults aged 70 and above. The evaluation was performed from a UK healthcare perspective over a lifetime time horizon, with costs reported in 2020 pounds (GBP) and outcomes reported as quality-adjusted life years (QALYs). All analyses used a £20,000 per QALY cost-effectiveness threshold.

RESULTS:

In the base case analysis, tranexamic acid was associated with an incremental cost-effectiveness ratio of £4885 per QALY gained, but the likelihood of it being cost-effective was highly dependent on the all-cause mortality treatment effect. The value of perfect information was £22.4 million, and the value of perfect information for parameters that could be collected in a trial was £21.9 million. The all-cause mortality risk ratio for tranexamic acid and the functional outcomes following TBI had the most impact on cost-effectiveness.

CONCLUSIONS:

There is a high degree of uncertainty in the cost-effectiveness of tranexamic acid for older adults experiencing mild TBI, meaning there is a high value of performing future research in the UK. The value in a global context is likely to be far higher.

• Authors: Jack Williams, Katharine Ker, Ian Roberts, Haleema Shakur-Still, Alec Miners
• Journal: Trials (Trials) Vol. 23 Issue 1 Pg. 370 (May 03 2022) ISSN: 1745-6215 [Electronic] England
• PMID: 35505387 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2022. The Author(s).

Chemical References

• Tranexamic Acid

Topics

• Aged
• Brain Concussion
• Cost-Benefit Analysis
• Humans
• Quality-Adjusted Life Years
• Tranexamic Acid (adverse effects)
• Uncertainty