Cost-Utility Analysis of rhBMP-2 Use in Adult Spinal Deformity Surgery.
dc.contributor.author | Jain, Amit | |
dc.contributor.author | Yeramaneni, Samrat | |
dc.contributor.author | Kebaish, Khaled M | |
dc.contributor.author | Raad, Micheal | |
dc.contributor.author | Gum, Jeffrey L | |
dc.contributor.author | Klineberg, Eric O | |
dc.contributor.author | Hassanzadeh, Hamid | |
dc.contributor.author | Kelly, Michael P | |
dc.contributor.author | Passias, Peter G | |
dc.contributor.author | Ames, Christopher P | |
dc.contributor.author | Smith, Justin S | |
dc.contributor.author | Shaffrey, Christopher I | |
dc.contributor.author | Bess, Shay | |
dc.contributor.author | Lafage, Virginie | |
dc.contributor.author | Glassman, Steve | |
dc.contributor.author | Carreon, Leah Y | |
dc.contributor.author | Hostin, Richard A | |
dc.contributor.author | International Spine Study Group | |
dc.date.accessioned | 2023-06-19T20:04:36Z | |
dc.date.available | 2023-06-19T20:04:36Z | |
dc.date.issued | 2020-07 | |
dc.date.updated | 2023-06-19T20:04:35Z | |
dc.description.abstract | Study designEconomic modeling of data from a multicenter, prospective registry.ObjectiveThe 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 dataASD surgery is expensive and presents risk of major complications. BMP is frequently used off-label to reduce the risk of pseudarthrosis.MethodsOf 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).ResultsBMP 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.ConclusionBMP 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 evidence2. | |
dc.identifier | 00007632-202007150-00018 | |
dc.identifier.issn | 0362-2436 | |
dc.identifier.issn | 1528-1159 | |
dc.identifier.uri | ||
dc.language | eng | |
dc.publisher | Ovid Technologies (Wolters Kluwer Health) | |
dc.relation.ispartof | Spine | |
dc.relation.isversionof | 10.1097/brs.0000000000003442 | |
dc.subject | International Spine Study Group | |
dc.subject | Spine | |
dc.subject | Humans | |
dc.subject | Spinal Curvatures | |
dc.subject | Pseudarthrosis | |
dc.subject | Postoperative Complications | |
dc.subject | Transforming Growth Factor beta | |
dc.subject | Recombinant Proteins | |
dc.subject | Spinal Fusion | |
dc.subject | Reoperation | |
dc.subject | Prospective Studies | |
dc.subject | Quality-Adjusted Life Years | |
dc.subject | Adult | |
dc.subject | Cost-Benefit Analysis | |
dc.subject | Bone Morphogenetic Protein 2 | |
dc.title | Cost-Utility Analysis of rhBMP-2 Use in Adult Spinal Deformity Surgery. | |
dc.type | Journal article | |
duke.contributor.orcid | Passias, Peter G|0000-0002-1479-4070|0000-0003-2635-2226 | |
duke.contributor.orcid | Shaffrey, Christopher I|0000-0001-9760-8386 | |
pubs.begin-page | 1009 | |
pubs.end-page | 1015 | |
pubs.issue | 14 | |
pubs.organisational-group | Duke | |
pubs.organisational-group | School of Medicine | |
pubs.organisational-group | Clinical Science Departments | |
pubs.organisational-group | Orthopaedic Surgery | |
pubs.organisational-group | Neurosurgery | |
pubs.publication-status | Published | |
pubs.volume | 45 |
Files
Original bundle
- Name:
- Cost–Utility Analysis of rhBMP-2 Use in Adult Spinal Deformity Surgery.pdf
- Size:
- 759.45 KB
- Format:
- Adobe Portable Document Format