Analysing uncertainty around costs of innovative medical technologies: The case of fibrin sealant (QUIXIL®) for total knee replacement

Steuten, Lotte Maria Gertruda; Vallejo-Torres, Laura; Bastide, Philippe; Buxton, Martin

doi:10.1016/j.healthpol.2008.05.002

Cited by 14 publications

(10 citation statements)

References 41 publications

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“…However, in the trial by Kluba et al [19], results showed that in daily clinical practice, a routine application of fibrin sealant adds costs to TKA treatment without reducing the number of transfused RBC. Steuten et al [25] performed a simple cost model to compare the cost of using a commercial fibrin sealant. Their conclusion is that whether using fibrin sealant is cost saving strongly depends on the amount used, the achieved reduction in hospital length of stay, and the price of fibrin sealant.…”

Section: Discussionmentioning

confidence: 99%

Is fibrin sealant effective and safe in total knee arthroplasty? A meta-analysis of randomized trials

et al. 2014

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The objective of this study was to evaluate the efficacy and safety of fibrin sealant in patients following total knee arthroplasty (TKA). A comprehensive literature search of the electronic databases PubMed, MEDLINE, Web of Science, and Cochrane Library for published randomized controlled trials (RCTs) was undertaken. The evidence base was critically appraised using a tool from the Cochrane Bone, Joint and Muscle Trauma Group. Eight RCTs involving 641 patients were included. The use of fibrin sealant significantly reduced postoperative drainage (weighted mean difference (WMD) −346, 95% confidence interval (CI) −496.29 to −197.54, P < 0.00001) and blood transfusions (risk ratio (RR) 0.47, 95% CI 0.35 to 0.63, P < 0.00001) and led to a significant improvement in the range of motion (WMD 16.59, 95% CI 6.92 to 26.25, P = 0.0008). However, using fibrin sealant did not significantly reduced total blood loss (WMD −305.25, 95% CI −679.44 to 68.95, P = 0.11). Regarding complications, there were no significant differences in any adverse events, fever, infection, or hematoma among the study groups. In conclusion, the present meta-analysis indicates that the use of fibrin sealant was effective and safe as a hemostatic therapy for patients with TKA.

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Section: Discussionmentioning

confidence: 99%

Is fibrin sealant effective and safe in total knee arthroplasty? A meta-analysis of randomized trials

et al. 2014

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“…In the literature, the results of five clinical studies of the use of fibrin glues to control bleeding in knee arthroplasty have been reported [4,6,14,[19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…In 2009, Steuten et al [6] analyzed the effect of fibrin glue administration on the duration of hospital stay and the onset of adverse events in patients undergoing knee arthroplasty. They concluded that a dosage of 10 ml (two kits) did not result in significant cost saving, as described in other fields.…”

Section: Discussionmentioning

confidence: 99%

“…Aim of our study was to compare, in total knee arthroplasty, the use of a 10 ml dosage, as mainly reported in literature, with a smaller dosage, as proposed by other authors for costbenefit reasons [6]. We designed a prospective randomized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant (5 and 10 ml) in patients undergoing total knee arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

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Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty

Notarnicola¹,

Moretti²,

Martucci³

et al. 2012

Blood Coagulation &Amp; Fibrinolysis

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In recent years, the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis. We designed a prospective randomized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant (5 and 10 ml) in patients undergoing total knee arthroplasty, as compared with the untreated control group. A total of 90 patients entered the study, randomly assigned to one of the three groups: treatment with 5 ml fibrin sealant (30 patients), with 10 ml fibrin sealant (30 patients) or no treatment (30 patients). A statistically significant difference in the mean reduction of hemoglobin concentrations was found on the first postoperative day in the treated groups as compared with the controls: 5 ml fibrin sealant (2.6 mg/dl) and 10 ml fibrin sealant (2.5 mg/dl) vs. controls (3.7 mg/dl) (P = 0.024). The mean number of blood transfusions was significantly lower in the treated groups: 5 ml (0.5) and 10 ml (0.3) of fibrin sealant vs. controls (1) (P = 0.0019). Functional recovery was also better in the treated groups: on the seventh day, the joint ROM (range of motion) was statistically superior in the 5 ml group (96.5°) and 10 ml group (98.8°) as compared with the controls (75.5°) (P < 0.0001). This study supports the efficacy of administering fibrin sealant in the perioperative management of bleeding after total knee arthroplasty and shows that a 5 ml dosage yields a comparable outcome to the 10 ml dosage previously reported in the literature.

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“…Steuton et al . [ 19 ] conducted a cost model analysis and found that fibrin thrombo-sealants were cost effective in primary knee joint replacement surgery. Extrapolating to revision hip replacement surgery, we deduce fibrin thrombo-sealants to be cost effective as well.…”

Section: Discussionmentioning

confidence: 99%

Use of a Thrombin Fibrin Sealant in Reducing Blood Loss in Revision Hip Arthroplasty

Ghoz¹,

Al-Khateeb²,

Rajkumar³

et al. 2015

Open Orthopaedics J

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We present a retrospective evaluation assessing the use of a novel fibrin sealant, Quixil® (OMRIX Biopharmaceuticals S.A.) in reducing blood transfusions following revision total hip replacement surgery. Forty four patients underwent revision total hip replacement surgery using Quixil®, while 45 patients underwent revision total hip replacement surgery without the use of Quixil®. The duration of surgery and patient demographics were similar in both groups. Average blood loss was 1,010ml in the Quixil® group versus 1,021ml in the non-Quixil group. The use of cell saver and intra-operative blood transfusion were similar in both groups. The mean pre-operative Haemoglobin was 13.0 g/dl in the Quixil® group versus 12.4 g/dl in the non-Quixil group. The mean post-operative haemoglobin was 10.2 g/dl and 9.1 g/dl in the Quixil® and non-Quixil groups respectively. There was no difference in the blood transfused post-operatively between the two groups. Total units of blood transfused in Quixil® versus non-Quixil group were 60 verus 86. Total units of intra-operative blood transfused in Quixil® versus non-Quixil group were 16 versus 23. The use of fibrin tissue adhesive in revision total hip arthroplasty seems to be an effective and reliable means to reduce blood-transfusion requirements and prevent post-operative decreases in hemoglobin.

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Analysing uncertainty around costs of innovative medical technologies: The case of fibrin sealant (QUIXIL®) for total knee replacement

Cited by 14 publications

References 41 publications

Is fibrin sealant effective and safe in total knee arthroplasty? A meta-analysis of randomized trials

Is fibrin sealant effective and safe in total knee arthroplasty? A meta-analysis of randomized trials

Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty

Use of a Thrombin Fibrin Sealant in Reducing Blood Loss in Revision Hip Arthroplasty

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