To establish the best dose regimen for tranexamic acid (TXA) in total hip replacement surgery.

Secondary analysis based on data from a multicenter double-blind randomized clinical trial.

Two hospitals in Spain.

TXA (2 doses) versus placebo.

Consecutive adults who underwent uncemented unilateral total replacement hip surgery.

We estimated the costs associated with TXA use (including consumables, drugs and nurse time) and allogeneic and autologous blood transfusions. For the cost-benefit analysis, we considered the spending on controls to estimate the benefits and the spending on patients in the intervention arms to estimate the costs. The net cost-benefit of TXA administration was calculated by subtracting the costs incurred per patient given TXA from the costs per patient given placebo.

The median total costs per patient were €2.7 (2.4–3.0) in the single-dose group, €6.5 (6.5–7.1) in the two-dose group and €0 (0–190) in the control group (p = 0.001). The blood transfusion costs were €1607.8, €1041.8 and €3115.3 in the single-dose, two-dose and control groups, respectively. The administration of two doses of TXA achieved a greater net cost-benefit than a single dose, the difference being €566 in terms of overall costs.

The administration of TXA is cost-effective, especially in the case of the two-dose regimen studied.