Quality of life and cost-effectiveness analysis of topical tranexamic acid and fibrin glue in femur fracture surgery.
Clinical trial
Cost-utility
Fibrin glue
Hip fracture
Quality of life
Tranexamic acid
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
31 Aug 2022
31 Aug 2022
Historique:
received:
31
01
2022
accepted:
16
08
2022
entrez:
31
8
2022
pubmed:
1
9
2022
medline:
8
9
2022
Statut:
epublish
Résumé
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. 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). 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). 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. ClinicalTrials.gov: NCT02150720. Date of registration 30/05/2014. Retrospectively registered.
Sections du résumé
BACKGROUND
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
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
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
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
BACKGROUND
ClinicalTrials.gov: NCT02150720. Date of registration 30/05/2014. Retrospectively registered.
Identifiants
pubmed: 36045358
doi: 10.1186/s12891-022-05775-y
pii: 10.1186/s12891-022-05775-y
pmc: PMC9429462
doi:
Substances chimiques
Fibrin Tissue Adhesive
0
Tranexamic Acid
6T84R30KC1
Banques de données
ClinicalTrials.gov
['NCT02150720']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
827Subventions
Organisme : Ministerio de Sanidad, Servicios Sociales e Igualdad
ID : EC11-341
Organisme : Ministerio de Sanidad, Servicios Sociales e Igualdad
ID : EC11-341
Organisme : Ministerio de Sanidad, Servicios Sociales e Igualdad
ID : EC11-341
Organisme : Fundación Mapfre
ID : SA/12/AYU/456
Organisme : Fundación Mapfre
ID : SA/12/AYU/456
Organisme : Fundación Mapfre
ID : SA/12/AYU/456
Informations de copyright
© 2022. The Author(s).
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