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Multicenter Study
. 2020 Jul 15;45(14):1009-1015.
doi: 10.1097/BRS.0000000000003442.

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

Amit Jain  1 , Samrat Yeramaneni  2 , Khaled M Kebaish  1 , Micheal Raad  1 , Jeffrey L Gum  3 , Eric O Klineberg  4 , Hamid Hassanzadeh  5 , Michael P Kelly  6 , Peter G Passias  7 , Christopher P Ames  8 , Justin S Smith  9 , Christopher I Shaffrey  10 , Shay Bess  7 , Virginie Lafage  7 , Steve Glassman  3 , Leah Y Carreon  3 , Richard A Hostin  2 ; International Spine Study Group
Affiliations
Multicenter Study

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

Amit Jain et al. Spine (Phila Pa 1976). .

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.

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References

    1. Hassanzadeh H, Jain A, El Dafrawy MH, et al. Clinical results and functional outcomes of primary and revision spinal deformity surgery in adults. J Bone Joint Surg Am 2013; 95:1413–1419.
    1. Jain A, Hassanzadeh H, Puvanesarajah V, et al. Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity: analysis of 3519 patients. J Neurosurg Spine 2017; 27:534–539.
    1. Sciubba DM, Yurter A, Smith JS, et al. A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent. Spine Deform 2015; 3:575–594.
    1. Kim YJ, Bridwell KH, Lenke LG, et al. Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis. J Bone Joint Surg Am 2006; 88:721–728.
    1. Kim YJ, Bridwell KH, Lenke LG, et al. Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine (Phila Pa 1976) 2006; 31:2329–2336.

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