title: [Health-economic considerations for the use of BMP-2 for spinal surgery in Germany].
abstract: BACKGROUND
  BMP-2 can replace autogenous bone grafting in lumbar one-level anterior lumbar interbody fusions (ALIF). The current G-DRG system does not reimburse the upfront price of 2,970 euro per BMP-2 application for hospitals in Germany. The purpose of the current study was to create a health economic model to evaluate the financial savings for health care providers (hospitals) and health care payers (health care insurance) that can be achieved by the use of BMP-2 in spine surgery.
  
  
  METHODS
  A previously published pooled data analysis was used in which BMP-2 showed significant improvements in the treatment after ALIF surgery compared to autogenous bone grafting, including earlier return to work time and reduced revision rates. These medical findings were transformed into economic data based on the regulations of the German health system of 2005.
  
  
  RESULTS
  The significantly shorter return to work time under BMP-2 treatment generates important financial savings for health care insurances offsetting the upfront prize of 2,970 euro for BMP-2. Savings for hospitals are mainly related to shorter surgery time due to the absence of the bone grafting procedure and faster discharge of the patient.
  
  
  CONCLUSIONS
  The combination of improved medical outcome by BMP-2 treatment for the patient and net savings for the entire health care system in Germany represents a "dominant" strategy from a health economic perspective. This implicates that BMP-2 in ALIF procedures is to be recommended from a health economic point of view for the German health care system.
authors.affiliation: Klinik für Unfallchirurgie, Universitätsklinikum Giessen-Marburg, Standort Giessen, Germany. volker.alt@chiru.med.uni-giessen.de
authors.forename: V
authors.initials: V
authors.lastname: Alt
authors.forename: H
authors.initials: H
authors.lastname: Haas
authors.forename: M A
authors.initials: MA
authors.lastname: Rauschmann
authors.forename: C
authors.initials: C
authors.lastname: Carstens
authors.forename: J
authors.initials: J
authors.lastname: Franke
authors.forename: A
authors.initials: A
authors.lastname: Eicher
authors.forename: A
authors.initials: A
authors.lastname: Bitschnau
authors.forename: R
authors.initials: R
authors.lastname: Schnettler
mesh_terms: D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings / Q000191:economics; D003953:Diagnosis-Related Groups / Q000191:economics; D004185:Disability Evaluation; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000592:standards; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008159:Lumbar Vertebrae / Q000601:surgery*; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D013123:Spinal Fusion / Q000191:economics*; D016212:Transforming Growth Factor beta / Q000191:economics* / Q000627:therapeutic use
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D016212:Transforming Growth Factor beta