Amit Jain1, Samrat Yeramaneni2, Khaled M Kebaish1, Micheal Raad1, Jeffrey L Gum3, Eric O Klineberg4, Hamid Hassanzadeh5, Michael P Kelly6, Peter G Passias7, Christopher P Ames8, Justin S Smith9, Christopher I Shaffrey10, Shay Bess7, Virginie Lafage7, Steve Glassman3, Leah Y Carreon3, Richard A Hostin2. 1. Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD. 2. Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX. 3. Norton Leatherman Spine Center, University of Louisville, Louisville, KY. 4. Davis Department of Orthopaedic Surgery, University of California, Sacramento, CA. 5. Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA. 6. Department of Orthopaedic Surgery, Washington University, St. Louis, MO. 7. Department of Orthopaedic Surgery, New York University, New York, NY. 8. Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, CA. 9. Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA. 10. Department of Neurosurgery, Duke University, Raleigh, NC.
Abstract
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.
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 humanbone 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.
Authors: Kai-Uwe LewandrowskI; Narendran Muraleedharan; Steven Allen Eddy; Vikram Sobti; Brian D Reece; Jorge Felipe Ramírez León; Sandeep Shah Journal: Int J Spine Surg Date: 2020-12
Authors: Quan Li; Zhi Zhao; Jingming Xie; Ying Zhang; Tao Li; Yingsong Wang Journal: Evid Based Complement Alternat Med Date: 2021-10-29 Impact factor: 2.629
Authors: Kai-Uwe Lewandrowski; Ivo Abraham; Jorge Felipe Ramírez León; Albert E Telfeian; Morgan P Lorio; Stefan Hellinger; Martin Knight; Paulo Sérgio Teixeira De Carvalho; Max Rogério Freitas Ramos; Álvaro Dowling; Manuel Rodriguez Garcia; Fauziyya Muhammad; Namath Hussain; Vicky Yamamoto; Babak Kateb; Anthony Yeung Journal: J Pers Med Date: 2022-06-29