London School of Hygiene & Tropical Medicine

How much would you pay for an extra year of healthy life? The cost of filling up your car at the petrol pumps? Researchers at the London School of Hygiene & Tropical Medicine (LSHTM) have found that a year of life could be saved for around the price of filling up the tank of an average family car in the UK - which is a fitting comparison bearing in mind that most of the patients who will benefit from this cheap life-saving drug have been hit by cars.

The results published in the PLoS One journal estimate that giving a drug called tranexamic acid – which reduces clot breakdown - could extend the lives of bleeding trauma patients at a cost in the UK of £38 ($64) for each additional year. In a low-income country such as Tanzania, the estimated cost per life year gained is £29 ($48), while in middle-income India the figure stands at £39 ($66). Giving tranexamic acid within three hours of injury saved an estimated 755, 372, 315 and life years per 1,000 bleeding trauma patients in the UK, Tanzania and India respectively.

This new analysis was based on evidence from the CRASH-2 trial involving more than 20,000 adults in 40 countries, which showed that early administration of tranexamic acid reduces the risk of death in bleeding trauma patients.

By assessing the cost of administering the drug and the cost of additional days in hospital in the UK, Tanzania and India, the researchers were able to measure the cost-effectiveness of the medical intervention in terms of life years gained.

The doctors who conducted this research are now calling on governments and aid agencies around the world to make the cheap life saving trauma drug free for patients wherever in the world they may be.

“Our result shows that giving this treatment to trauma victims is at least as cost effective as other interventions such as giving HIV drugs for which governments have been rightly persuaded to provide the drug free of charge - exactly the same arguments can be made for making two shots of tranexamic acid free for all seriously injured patients,” say Dr Pablo Perel and Ms Haleema Shakur, who are based in LSHTM’s Clinical Trials Unit. “About 1.2 million people die because of road traffic crashes, that is an average 3,242 people killed daily on the world's roads. Road traffic crashes are already at epidemic level and rising in Asia, Africa and Latin America and can be viewed as a neglected tropical disease. Prevention is critical, but even with the best prevention efforts there will still be millions of patients requiring emergency care. We will be writing to aid agencies, which pay for road building, and governments, which subsidise petrol, to make tranexamic freely available to ensure that road traffic victims receive this cost-effective intervention.”

• “Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial” by Carla Guerriero et al - http://dx.plos.org/10.1371/journal.pone.0018987