Quality of life and cost-effectiveness analysis of topical tranexamic acid and fibrin glue in femur fracture surgery

A Merchán-Galvis, M Posso, E Canovas, M Jordán, X Aguilera, M J Martinez-Zapata, A Merchán-Galvis, M Posso, E Canovas, M Jordán, X Aguilera, M J Martinez-Zapata

Abstract

Background: We assessed quality of life (QoL) of patients undergoing surgery for proximal femur fracture and performed a cost-effectiveness analysis of haemostatic drugs for reducing postoperative bleeding.

Methods: We analysed data from an open, multicentre, parallel, randomized controlled clinical trial (RCT) that assessed the efficacy and safety of tranexamic acid (TXA group) and fibrin glue (FG group) administered topically prior to surgical closure, compared with usual haemostasis methods (control group). For this study we conducted a cost-effectiveness analysis of these interventions from the Spanish Health System perspective, using a time horizon of 12 months. The cost was reported in $US purchasing power parity (USPPP). We calculated the incremental cost-effectiveness ratio (ICER) per QALY (quality-adjusted life-year).

Results: We included 134 consecutive patients from February 2013 to March 2015: 42 patients in the TXA group, 46 in the FG group, and 46 in the control group. Before the fracture, EuroQol visual analogue scale (EQ-VAS) health questionnaire score was 68.6. During the 12 months post-surgery, the intragroup EQ-VAS improved, but without reaching pre-fracture values. There were no differences between groups for EQ-VAS and EuroQol 5 dimensions 5 levels (EQ-5D-5L) health questionnaire score, nor in hospital stay costs or medical complication costs. Nevertheless, the cost of one FG treatment was significantly higher (399.1 $USPPP) than the cost of TXA (12.9 $USPPP) or usual haemostasis (0 $USPPP). When comparing the cost-effectiveness of the interventions, FG was ruled out by simple dominance since it was more costly (13,314.7 $USPPP) than TXA (13,295.2 $USPPP) and less effective (utilities of 0.0532 vs. 0.0734, respectively). TXA compared to usual haemostasis had an ICER of 15,289.6 $USPPP per QALY).

Conclusions: There were no significant differences between the intervention groups in terms of postoperative changes in QoL. However, topical TXA was more cost-effective than FG or usual haemostasis.

Trial registration: ClinicalTrials.gov: NCT02150720. Date of registration 30/05/2014. Retrospectively registered.

Keywords: Clinical trial; Cost-utility; Fibrin glue; Hip fracture; Quality of life; Tranexamic acid.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study flow chart of patients that undergoing Quality of Life
Fig. 2
Fig. 2
Evolution of QoL related to health for global visual analogue scale and by treatment. Notes: Multi-factor ANOVA. VAS evolution at post-surgery 5th day, 1-, 6- and 12-months follow-up: p < 0.001. Comparison between treatments at post-surgery 5th day, 1-, 6- and 12-months follow-up: p = 0.331
Fig. 3
Fig. 3
Evolution of QoL related to health for EQ5D5L and by treatment. Notes: Multi-factor ANOVA. EQ5D5L evolution at post-surgery 5th day, 1-, 6- and 12-months follow-up: p < 0.001. Comparison between treatments at post-surgery 5th day, 1-, 6- and 12-months follow-up: p = 0.121
Fig. 4
Fig. 4
Sensitivity analysis of the incremental cost-utility ratio (ICUR). Notes: QALYs: Quality adjusted life years. The variation in QALYs was the 95% Confidence Interval upper (0.106704) and lower (0.040027) value of the mean utility (0.073366) in the topical TXA group. USPPP: $US Purchasing Power Parities are the rates of currency conversion that equalise the purchasing power of different currencies by eliminating the differences in price levels between countries. The variation in topical Tranexamic Acid (TXA) cost ranged from zero (control cost) and 25.8 USPPP, which is 100% higher than the unit cost of TXA

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