The Cost-Effectiveness of Tranexamic Acid for Preventing Periprosthetic Joint Infection following Total Shoulder Arthroplasty: A Break-Even Analysis.

Abstract

The use of tranexamic acid has become widespread in orthopedics to promote hemostasis and has been successfully used to reduce blood loss and infection risk in joint arthroplasty. However, the cost-effectiveness of routine tranexamic acid use for the prevention of periprosthetic infections in total shoulder arthroplasty (TSA) remains unknown. The acquisition cost of tranexamic acid ($5.22) for our institution, along with values from the literature for the average cost of infection-related care ($55,243) and the baseline infection rates for patients without tranexamic acid use (0.70%), were used to perform a break-even analysis. The absolute risk reduction of infection necessary to justify the prophylactic use of tranexamic acid in shoulder arthroplasty was calculated from the non-treated and break-even infection rates. Tranexamic acid is considered cost effective if it prevents one infection out of 10,583 TSA's (absolute risk reduction [ARR] = 0.009%). It is economically justifiable with an ARR range of 0.001% at a cost of $0.50/g to 0.181% at $100/g. At varying costs of infection-related care ($10,000 - $100,000) and varying baseline infection rates (0.50% - 8.00%), routine use of tranexamic acid remained cost effective. The use of tranexamic acid is an economically viable practice for infection prevention following shoulder arthroplasty if it reduces the infection rate by 0.009%. Future, prospective studies should be conducted to observe whether tranexamic acid reduces the infection rate by more than 0.009%, showing cost-effectiveness.