Cost-benefit analysis of intra-articular injection of tranexamic acid in total knee arthroplasty

Abstract

INTRODUCTION: Recent studies reported that intra-articular administration of tranexamic acid (IaTXA) in total knee arthroplasty (TKA) reduced transfusion rate, but the optimal regimen is not yet established. This study aimed to provide a cost-benefit analysis of our regimen. MATERIALS AND METHODS: The inclusion criterion was patients undergoing unilateral primary TKA with the diagnosis of primary osteoarthritis, and exclusion criteria were patients with contra-indication of IaTXA. The patients were included into 2 groups: patients with IaTXA from July 2014 to June 2015 (TXA group: 1 gm TXA was directly injected into knee joint) and those without IaTXA from July 2013 to June 2014 as historical control (non-TXA group). All TKAs were conducted by same surgical team with standardised techniques and perioperative management. Demographics and perioperative parameters were collected for comparison. The primary (transfusion rate) and secondary (thromboembolism complications and cost) outcomes were compared between TXA and non-TXA groups. RESULTS: A total of 375 patients were included in this study, including 190 in TXA group and 185 in non-TXA group. Both groups were comparable in demographics and perioperative parameters. The TXA group had statistically significantly lower transfusion rate (9.4% vs. 34.6%, p=0.005). No thromboembolism complications were observed in both groups. This led to saving HKD$238.31 per patient based on transfusion cost alone after accounting for the cost of TXA. DISCUSSION AND CONCLUSION: It showed that our regimen of IaTXA could reduce transfusion rate, and was cost-saving without increasing complications of thromboembolism.