TY - JOUR
T1 - Cost-Utility Analysis of rhBMP-2 Use in Adult Spinal Deformity Surgery
AU - Jain, Amit
AU - Yeramaneni, Samrat
AU - Kebaish, Khaled M.
AU - Raad, Micheal
AU - Gum, Jeffrey L.
AU - Klineberg, Eric O.
AU - Hassanzadeh, Hamid
AU - Kelly, Michael P.
AU - Passias, Peter G.
AU - Ames, Christopher P.
AU - Smith, Justin S.
AU - Shaffrey, Christopher I.
AU - Bess, Shay
AU - Lafage, Virginie
AU - Glassman, Steve
AU - Carreon, Leah Y.
AU - Hostin, Richard A.
N1 - Publisher Copyright:
© 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020/7/15
Y1 - 2020/7/15
N2 - Study Design.Economic modeling of data from a multicenter, prospective registry.Objective.The aim of this study was to analyze the cost utility of recombinant human bone morphogenetic protein-2 (BMP) in adult spinal deformity (ASD) surgery.Summary of Background Data.ASD surgery is expensive and presents risk of major complications. BMP is frequently used off-label to reduce the risk of pseudarthrosis.Methods.Of 522 ASD patients with fusion of five or more spinal levels, 367 (70%) had at least 2-year follow-up. Total direct cost was calculated by adding direct costs of the index surgery and any subsequent reoperations or readmissions. Cumulative quality-adjusted life years (QALYs) gained were calculated from the change in preoperative to final follow-up SF-6D health utility score. A decision-analysis model comparing BMP versus no-BMP was developed with pseudarthrosis as the primary outcome. Costs and benefits were discounted at 3%. Probabilistic sensitivity analysis was performed using mixed first-order and second-order Monte Carlo simulations. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates (Alpha = 0.05).Results.BMP was used in the index surgery for 267 patients (73%). The mean (±standard deviation) direct cost of BMP for the index surgery was $14,000 ± $6400. Forty patients (11%) underwent revision surgery for symptomatic pseudarthrosis (BMP group, 8.6%; no-BMP group, 17%; P = 0.022). The mean 2-year direct cost was significantly higher for patients with pseudarthrosis ($138,000 ± $17,000) than for patients without pseudarthrosis ($61,000 ± $25,000) (P < 0.001). Simulation analysis revealed that BMP was associated with positive incremental utility in 67% of patients and considered favorable at a willingness-to-pay threshold of $150,000/QALY in >52% of patients.Conclusion.BMP use was associated with reduction in revisions for symptomatic pseudarthrosis in ASD surgery. Cost-utility analysis suggests that BMP use may be favored in ASD surgery; however, this determination requires further research.Level of Evidence: 2.
AB - Study Design.Economic modeling of data from a multicenter, prospective registry.Objective.The aim of this study was to analyze the cost utility of recombinant human bone morphogenetic protein-2 (BMP) in adult spinal deformity (ASD) surgery.Summary of Background Data.ASD surgery is expensive and presents risk of major complications. BMP is frequently used off-label to reduce the risk of pseudarthrosis.Methods.Of 522 ASD patients with fusion of five or more spinal levels, 367 (70%) had at least 2-year follow-up. Total direct cost was calculated by adding direct costs of the index surgery and any subsequent reoperations or readmissions. Cumulative quality-adjusted life years (QALYs) gained were calculated from the change in preoperative to final follow-up SF-6D health utility score. A decision-analysis model comparing BMP versus no-BMP was developed with pseudarthrosis as the primary outcome. Costs and benefits were discounted at 3%. Probabilistic sensitivity analysis was performed using mixed first-order and second-order Monte Carlo simulations. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates (Alpha = 0.05).Results.BMP was used in the index surgery for 267 patients (73%). The mean (±standard deviation) direct cost of BMP for the index surgery was $14,000 ± $6400. Forty patients (11%) underwent revision surgery for symptomatic pseudarthrosis (BMP group, 8.6%; no-BMP group, 17%; P = 0.022). The mean 2-year direct cost was significantly higher for patients with pseudarthrosis ($138,000 ± $17,000) than for patients without pseudarthrosis ($61,000 ± $25,000) (P < 0.001). Simulation analysis revealed that BMP was associated with positive incremental utility in 67% of patients and considered favorable at a willingness-to-pay threshold of $150,000/QALY in >52% of patients.Conclusion.BMP use was associated with reduction in revisions for symptomatic pseudarthrosis in ASD surgery. Cost-utility analysis suggests that BMP use may be favored in ASD surgery; however, this determination requires further research.Level of Evidence: 2.
KW - Monte Carlo simulation
KW - adult spinal deformity
KW - cost-utility analysis
KW - health economics
KW - health utility
KW - nonunion
KW - pseudarthrosis
KW - recombinant human bone morphogenetic protein-2
KW - reoperation
KW - revision surgery
UR - https://www.scopus.com/pages/publications/85087469016
U2 - 10.1097/BRS.0000000000003442
DO - 10.1097/BRS.0000000000003442
M3 - Article
C2 - 32097274
AN - SCOPUS:85087469016
SN - 0362-2436
VL - 45
SP - 1009
EP - 1015
JO - Spine
JF - Spine
IS - 14
ER -