Pharmacologic Hemostatic Agents in Total Joint Arthroplasty-A Cost-Effectiveness Analysis

Area of Science:

• Orthopedic Surgery
• Pharmacoeconomics
• Anesthesiology

Background:

• Total knee and hip arthroplasties carry risks of significant blood loss, impacting patient morbidity and mortality.
• Pharmacological antifibrinolytics like ε-aminocaproic acid (EACA) and tranexamic acid (TXA) are used to mitigate perioperative bleeding.
• The costs and associated morbidities of EACA and TXA necessitate a cost-effectiveness evaluation for optimal strategy selection.

Purpose of the Study:

• To conduct a cost-effectiveness analysis comparing TXA, EACA, and no pharmacologic hemostatic agent for minimizing blood loss in total joint arthroplasties.
• To determine the most economically viable and effective strategy for managing perioperative blood loss in these procedures.

Main Methods:

• A cost-effectiveness model was developed using quality-adjusted life expectancy (in days) and costs (in USD).
• Data on complications, probabilities, utility values, and medical costs were sourced from the medical literature.
• A 10-year time horizon and a $100,000 willingness-to-pay threshold were utilized in the model.

Main Results:

• Tranexamic acid (TXA) demonstrated superior cost-effectiveness, with a total cost of $459.77 and effectiveness of 3411.19 quality-adjusted life days.
• EACA incurred higher costs ($1174.87) and yielded lower effectiveness (3342.69 days), while no agent cost $951.22 and provided 3248.02 days.
• Sensitivity analyses confirmed TXA as the dominant strategy across clinically plausible probabilities for transfusion and myocardial infarction.

Conclusions:

• TXA is the most cost-effective strategy for reducing intraoperative blood loss in total hip and knee arthroplasties compared to EACA and no pharmacologic agent.
• The findings supporting TXA's dominance are robust and hold true even when considering variations in clinically plausible probabilities.