The cost-effectiveness of tranexamic acid for preventing blood transfusions following reverse total shoulder arthroplasty: a break-even analysis

Abstract

BackgroundThe administration of tranexamic acid (TXA) in patients undergoing shoulder arthroplasty is a safe and effective means of reducing blood loss and blood transfusions. Due to its low cost and ability to prevent costly complications, TXA’s use is thought to be a cost-saving practice. The purpose of this study was to determine the cost-effectiveness of TXA in preventing blood transfusions in patients undergoing reverse shoulder arthroplasty (RSA). MethodsThe cost of TXA ($5.22) and the cost of a blood transfusion ($299.31) from our institution, as well as baseline published blood transfusion rates following RSA (14.3%) without the administration of TXA, were included in a break-even model to calculate the absolute risk reduction (ARR) that the routine use of TXA would need to be considered economically justifiable. To account for variance in baseline transfusion rates, the cost of TXA, and the cost of blood transfusion across institutions, sensitivity analyses were conducted in which the break-even transfusion rate and ARR were calculated across a wide range for each variable. ResultsTXA is deemed cost-effective if it prevents one blood transfusion out of 57 RSAs (ARR = 1.74%). It is economically viable at varying drug costs ($1-$25), blood transfusion costs ($50-$5000), and baseline transfusion rates (2.00%-50.00%). ConclusionUsing the cost parameters at a single institution, the current study found that TXA would be cost-effective in preventing blood transfusion if its routine use achieves an ARR greater than 1.74% following RSA. As the ARR has been demonstrated in the literature to be greater than 1.74%, TXA can be considered cost-effective in preventing blood transfusion following RSA.