Cost-Utility Analysis of rhBMP-2 Use in Adult Spinal Deformity Surgery.

dc.contributor.author

Jain, Amit

dc.contributor.author

Yeramaneni, Samrat

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Kebaish, Khaled M

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Raad, Micheal

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Gum, Jeffrey L

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Klineberg, Eric O

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Hassanzadeh, Hamid

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Kelly, Michael P

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Passias, Peter G

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Ames, Christopher P

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Smith, Justin S

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Shaffrey, Christopher I

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Bess, Shay

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Lafage, Virginie

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Glassman, Steve

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Carreon, Leah Y

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Hostin, Richard A

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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

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2023-06-19T20:04:35Z

dc.description.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.
dc.identifier

00007632-202007150-00018

dc.identifier.issn

0362-2436

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1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/28142

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

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10.1097/brs.0000000000003442

dc.subject

International Spine Study Group

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Spine

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Humans

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Spinal Curvatures

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Pseudarthrosis

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Postoperative Complications

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Transforming Growth Factor beta

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Recombinant Proteins

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Spinal Fusion

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Reoperation

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Prospective Studies

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Quality-Adjusted Life Years

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Adult

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Cost-Benefit Analysis

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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

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

pubs.volume

45

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