Elsevier

The Spine Journal

Volume 2, Issue 5, Supplement, September–October 2002, Page 120
The Spine Journal

Abstract
An economic analysis of bone morphogenic protein

https://doi.org/10.1016/S1529-9430(02)00381-9Get rights and content

Abstract

Purpose of study: An economic model was developed to compare costs of bone morphogenic protein (BMP) versus autogenous iliac crest bone graft (AICBG) for spinal fusion. Fusion and complications rates were based on two multicenter, randomized, clinical trials comparing stand-alone anterior lumbar interbody fusion with BMP (recombinant human BMP-2 [rhBMP-2]) on an absorbable collagen sponge versus AICBG in either a tapered cylindrical cage (LT-CAGE clinical trial) or a threaded cortical bone dowel (Bone Dowel clinical trial). The objective of this study was to determine the effect of use of BMP on the process of care and costs of spinal fusion during the index hospitalization and in the subsequent 2 years. The economic model was developed based on data from clinical trials, peer-reviewed literature and expert opinion.

Methods used: We identified and assigned costs to medical resources that would increase or decrease with the use of BMP. Direct medical costs in two distinct contexts were considered: those incurred by the hospital during the index hospitalization and those incurred during both the index hospitalization and 2 years afterwards. The price of BMP in the base case analyses was $3,380. The costs are reported in 2001 US dollars.

of findings: In the base case analysis over a period of 2 years, total direct medical costs for spinal fusion were similar for BMP and AICBG ($9 difference favoring BMP) using clinical trial fusion rates of 94.5% and 88.7%, respectively (LT-CAGE clinical trial). In a sensitivity analysis over a period of 2 years using fusion rates of 100% for rhBMP-2 and 68.4% for AICBG, respectively (Bone Dowel clinical trial), BMP resulted in $4,564 in savings. In the base case analysis from a hospital perspective (index hospitalization only), nearly half of the $3,380 price of BMP was offset.

Relationship between findings and existing knowledge: The upfront price of BMP is likely to be offset to a significant extent by reductions in the use of other medical resources, particularly if costs incurred during the 2-year period after the index hospitalization are taken into account.

Overall significance of findings: Under the base case assumptions (fusion success rates of 94.5% for rhBMP-2 and 88.7% for AICBG; LT-CAGE clinical trial) over a 2-year period, cost-neutrality was achieved at a BMP price of $3,389. Sensitivity analyses indicate that under an alternative scenario about the fusion success rates (100.0% for rhBMP-2 and 68.4% for AICBG; Bone Dowel clinical trial), cost-neutrality would be achieved over a 2-year period at a BMP price of $7,944.

Disclosures: Device or drug: rhBMP-2. Status: not approved.

Conflict of interest: David Polly, Jr., grant research support: Medtronic Sofamor Danek and De Puy Acromed.

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