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The cost–utility of intraoperative tranexamic acid in adult spinal deformity patients undergoing long posterior spinal fusion

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Abstract

Purpose

This study aims to evaluate the cost-utility of intraoperative tranexamic acid (TXA) in adult spinal deformity (ASD) patients undergoing long posterior (≥ 5 vertebral levels) spinal fusion.

Methods

A decision-analysis model was built for a hypothetical 60-year-old adult patient with spinal deformity undergoing long posterior spinal fusion. A comprehensive review of the literature was performed to obtain event probabilities, costs and health utilities at each node. Health utilities were utilized to calculate Quality-Adjusted Life Years (QALYs). A base-case analysis was carried out to obtain the incremental cost and effectiveness of intraoperative TXA. Probabilistic sensitivity analysis was performed to evaluate uncertainty in our model and obtain mean incremental costs, effectiveness, and net monetary benefits. One-way sensitivity analyses were also performed to identify the variables with the most impact on our model.

Results

Use of intraoperative TXA was the favored strategy in 88% of the iterations. The mean incremental utility ratio for using intraoperative TXA demonstrated higher benefit and lower cost while being lower than the willingness-to-pay threshold set at $50,000 per quality adjusted life years. Use of intraoperative TXA was associated with a mean incremental net monetary benefit (INMB) of $3743 (95% CI 3492–3995). One-way sensitivity analysis reported cost of blood transfusions due to post-operative anemia to be a major driver of cost–utility analysis.

Conclusion

Use of intraoperative TXAs is a cost-effective strategy to reduce overall perioperative costs related to post-operative blood transfusions. Administration of intraoperative TXA should be considered for long fusions in ASD population when not explicitly contra-indicated due to patient factors.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA

    Miguel A. Cartagena-Reyes, Juan A. Silva-Aponte, Gabriel I. Nazario-Ferrer, Gregory A. Benes, Ananya Choudhary, Micheal Raad, Farah N. Musharbash & Amit Jain

  2. Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University, 1800 Orleans St., Zayed 6208, Baltimore, MD, 21287, USA

    Steven M. Frank

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Contributions

MAC-R and BS: (1) made substantial contributions to the conception or design of the work, (2) drafted the work or revised it critically for important intellectual content, (3) approved the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JAS-A and BS: (1) made substantial contributions to the conception or design of the work, (2) drafted the work or revised it critically for important intellectual content, (3) approved the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GIN-F and BS: (1) made substantial contributions to the conception or design of the work, (2) drafted the work or revised it critically for important intellectual content, (3) approved the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GB and BS: (1) made substantial contributions to the conception or design of the work, (2) drafted the work or revised it critically for important intellectual content, (3) approved the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AC and BS: (1) made substantial contributions to the conception or design of the work, (2) drafted the work or revised it critically for important intellectual content, (3) approved the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MR and MD: (1) made substantial contributions to the conception or design of the work, (2) drafted the work or revised it critically for important intellectual content, (3) approved the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SMF and MD: (1) made substantial contributions to the conception or design of the work, (2) revised the work critically for important intellectual content, (3) approved the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FNM and MD: (1) made substantial contributions to the conception or design of the work, (2) revised the work critically for important intellectual content, (3) approved the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AJ, MD, and MBA: (1) made substantial contributions to the conception or design of the work, (2) drafted the work or revised it critically for important intellectual content, (3) approved the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Amit Jain.

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Cartagena-Reyes, M.A., Silva-Aponte, J.A., Nazario-Ferrer, G.I. et al. The cost–utility of intraoperative tranexamic acid in adult spinal deformity patients undergoing long posterior spinal fusion. Spine Deform 12, 587–593 (2024). https://doi.org/10.1007/s43390-023-00818-3

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