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Pharmacologic Hemostatic Agents in Total Joint Arthroplasty-A Cost-Effectiveness Analysis.
Ramkumar, Dipak B; Ramkumar, Niveditta; Tapp, Stephanie J; Moschetti, Wayne E.
Afiliación
  • Ramkumar DB; Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; Department of Orthopaedic Surgery, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; The Dartmouth Institute of Health Policy and Clinical Practice, Hanover, New
  • Ramkumar N; The Dartmouth Institute of Health Policy and Clinical Practice, Hanover, New Hampshire.
  • Tapp SJ; The Dartmouth Institute of Health Policy and Clinical Practice, Hanover, New Hampshire.
  • Moschetti WE; Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; Department of Orthopaedic Surgery, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
J Arthroplasty ; 33(7): 2092-2099.e9, 2018 07.
Article en En | MEDLINE | ID: mdl-29605152
ABSTRACT

BACKGROUND:

Total knee and hip arthroplasties can be associated with substantial blood loss, affecting morbidity and even mortality. Two pharmacological antifibrinolytics, ε-aminocaproic acid (EACA) and tranexamic acid (TXA) have been used to minimize perioperative blood loss, but both have associated morbidity. Given the added cost of these medications and the risks associated with then, a cost-effectiveness analysis was undertaken to ascertain the best strategy.

METHODS:

A cost-effectiveness model was constructed using the payoffs of cost (in United States dollars) and effectiveness (quality-adjusted life expectancy, in days). The medical literature was used to ascertain various complications, their probabilities, utility values, and direct medical costs associated with various health states. A time horizon of 10 years and a willingness to pay threshold of $100,000 was used.

RESULTS:

The total cost and effectiveness (quality-adjusted life expectancy, in days) was $459.77, $951.22, and $1174.87 and 3411.19, 3248.02, and 3342.69 for TXA, no pharmacologic hemostatic agent, and EACA, respectively. Because TXA is less expensive and more effective than the competing alternatives, it was the favored strategy. One-way sensitivity analyses for probability of transfusion and myocardial infarction for all 3 strategies revealed that TXA remains the dominant strategy across all clinically plausible values.

CONCLUSION:

TXA, when compared with no pharmacologic hemostatic agent and with EACA, is the most cost-effective strategy to minimize intraoperative blood loss in hip and knee total joint arthroplasties. These findings are robust to sensitivity analyses using clinically plausible probabilities.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Pérdida de Sangre Quirúrgica / Modelos Económicos / Artroplastia de Reemplazo de Cadera / Artroplastia de Reemplazo de Rodilla / Antifibrinolíticos Tipo de estudio: Etiology_studies / Health_economic_evaluation / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: J Arthroplasty Asunto de la revista: ORTOPEDIA Año: 2018 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Pérdida de Sangre Quirúrgica / Modelos Económicos / Artroplastia de Reemplazo de Cadera / Artroplastia de Reemplazo de Rodilla / Antifibrinolíticos Tipo de estudio: Etiology_studies / Health_economic_evaluation / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: J Arthroplasty Asunto de la revista: ORTOPEDIA Año: 2018 Tipo del documento: Article