Cost-benefit analysis of the use of tranexamic acid in total replacement hip surgery.

Study Objective: To establish the best dose regimen for tranexamic acid (TXA) in total hip replacement surgery.

Design: Secondary analysis based on data from a multicenter double-blind randomized clinical trial.

Setting: Two hospitals in Spain.

Interventions: TXA (2 doses) versus placebo.

Patients: Consecutive adults who underwent uncemented unilateral total replacement hip surgery.

Measurements: We estimated the costs associated with TXA use (including consumables, drugs and nurse time) and allogeneic and autologous blood transfusions. For the cost-benefit analysis, we considered the spending on controls to estimate the benefits and the spending on patients in the intervention arms to estimate the costs. The net cost-benefit of TXA administration was calculated by subtracting the costs incurred per patient given TXA from the costs per patient given placebo.

Main Results: The median total costs per patient were €2.7 (2.4-3.0) in the single-dose group, €6.5 (6.5-7.1) in the two-dose group and €0 (0-190) in the control group (p = 0.001). The blood transfusion costs were €1607.8, €1041.8 and €3115.3 in the single-dose, two-dose and control groups, respectively. The administration of two doses of TXA achieved a greater net cost-benefit than a single dose, the difference being €566 in terms of overall costs.

Conclusions: The administration of TXA is cost-effective, especially in the case of the two-dose regimen studied.