title: Cost Analysis of Tranexamic Acid in Anemic Total Joint Arthroplasty Patients.
abstract: BACKGROUND
  Preoperative anemia is present in 20% of total joint arthroplasty patients. Current preoperative treatment options, including iron supplementation (FE) and erythropoietin (EPO), are expensive. Tranexamic acid (TXA) has been adopted as an intraoperative adjunct to decrease blood loss. Our hypothesis is that TXA is a cost-effective treatment compared to FE and EPO in anemic patients.
  
  
  METHODS
  In this study, a cost analysis was performed, comparing the material costs of TXA and packed red blood cells (PRBCs) to the theoretical administration and material costs of FE and EPO per standard preoperative anemia protocol.
  
  
  RESULTS
  A total of 243 patients were included in the study. Of this group, 18.5% (45/243) had preoperative anemia. The rate of transfusion was 6.7% (3/45), and 5 units of PRBCs was transfused. The combined cost of TXA and PRBCs was $5317.08. Even assuming a best-case scenario with FE or EPO treatment without a postoperative PRBC requirement, the cost of treatment would range from 2 to 17 times more than treatment with TXA. An additional 50 units of PRBC (1.1 units per patient) would need to be transfused for the cost of TXA treatment to be equivalent to FE or EPO treatment.
  
  
  CONCLUSIONS
  Tranexamic acid is significantly less expensive than FE or EPO as a treatment option for total joint arthroplasty patients presenting with preoperative anemia. It is a cost-effective adjunct for limiting transfusion rates in this patient population. We recommend that new preoperative anemia levels that necessitate preoperative intervention be established.
authors.affiliation: University of California, Irvine School of Medicine, Irvine, California.
authors.forename: Duy L
authors.initials: DL
authors.lastname: Phan
authors.affiliation: University of California, Irvine School of Medicine, Irvine, California.
authors.forename: Fiyinfoluwa
authors.initials: F
authors.lastname: Ani
authors.affiliation: Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
mesh_terms: D000368:Aged; D000740:Anemia / Q000628:therapy; D000933:Antifibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use; D001178:Arthroplasty / Q000191:economics*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000191:economics*; D003362:Cost-Benefit Analysis; D017707:Erythrocyte Transfusion / Q000191:economics; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005290:Ferric Compounds / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D057234:Preoperative Period; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D005290:Ferric Compounds; D004921:Erythropoietin; C024823:ferric sulfate; D014148:Tranexamic Acid
keywords: erythropoietin; iron sulfate; preoperative anemia; total joint arthroplasty; tranexamic acid