Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, JHOC 5230, Baltimore, MD, 21287, USA.
Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University, 1800 Orleans St., Zayed 6208, Baltimore, MD, 21287, USA.
Spine Deform. 2024 May;12(3):587-593. doi: 10.1007/s43390-023-00818-3. Epub 2024 Mar 1.
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.
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.
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.
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.
本研究旨在评估术中氨甲环酸（TXA）在接受长后路（≥5 个椎体水平）脊柱融合术的成人脊柱畸形（ASD）患者中的成本-效用。
为一名 60 岁患有脊柱畸形的成年患者建立了一个接受长后路脊柱融合术的决策分析模型。对文献进行了全面回顾，以获得每个节点的事件概率、成本和健康效用。健康效用用于计算质量调整生命年（QALYs）。进行了基础案例分析，以获得术中 TXA 的增量成本和效果。进行概率敏感性分析以评估模型中的不确定性，并获得平均增量成本、效果和净货币收益。还进行了单因素敏感性分析，以确定对模型影响最大的变量。
在 88%的迭代中，使用术中 TXA 是首选策略。使用术中 TXA 的平均增量效用比显示出更高的收益和更低的成本，同时低于设定的每质量调整生命年 50000 美元的支付意愿阈值。使用术中 TXA 与平均增量净货币收益（INMB）为 3743 美元（95%CI 3492-3995）相关。单因素敏感性分析报告术后贫血导致的输血成本是成本-效用分析的主要驱动因素。
使用术中 TXA 是一种降低与术后输血相关的整体围手术期成本的具有成本效益的策略。在 ASD 人群中，当由于患者因素而明确不适用时，应考虑在长融合时使用术中 TXA。
