Cost Analysis of Use of Tranexamic Acid to Prevent Major Bleeding Complications in Hip and Knee Arthroplasty Surgery

We used decision analysis to assess the cost profile associated with preoperative use of tranexamic acid (TXA) to prevent major bleeding complications associated
with hip and knee arthroplasty surgery. We defined major bleeding complications as blood loss sufficient to require transfusion or surgical evacuation of a postoperative hematoma.

In the absence of a reduction in revision rates, using current cost data, TXA use is not cost-saving for institutions with baseline blood transfusion rates under 25%. For centers with baseline transfusion rates above 25%, however, TXA becomes increasingly cost-saving as the reduction in transfusion rates seen with use of the drug increases, but a minimum 12% reduction in transfusion rates is needed, even if the expected baseline transfusion rate is 100%. Nevertheless, TXA use is much more likely to be cost-saving, regardless of transfusion rates, if it leads to a reduction in need for revision surgery.