title: Cost-Utility Analysis of 1- and 2-Level Dorsal Lumbar Fusions With and Without Recombinant Human Bone Morphogenic Protein-2 at 1-Year Follow-Up.
abstract: METHODS
  A retrospective 1-year cost-utility analysis.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of using recombinant human bone morphogenic protein (rhBMP-2) in addition to autograft for 1- and 2-level lumbar fusions.
  
  
  BACKGROUND
  rhBMP-2 has been studied extensively to identify its benefits, risks, patient outcomes, and costs relative to autograft [local bone or iliac crest bone graft (ICBG)]. This study seeks to analyze the cost-effectiveness of adding rhBMP-2 to autograft versus without rhBMP-2 in lumbar fusions.
  
  
  METHODS
  Thirty-three patients receiving rhBMP-2 in addition to either local bone autograft or ICBG (rhBMP-2 cohort) and 42 patients receiving only local bone autograft or ICBG (control cohort) for 1- or 2-level dorsal lumbar fusion were analyzed. This included posterolateral fusion, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion. One-year postoperative health outcomes were assessed based on Visual Analogue Scale, Pain Disability Questionnaire, Patient Health Questionnaire, and EuroQol-5 Dimensions questionnaires. Direct medical costs were estimated using Medicare national payment amounts and indirect costs were based on patient missed work days and patient income. Postoperative 1-year cost-utility ratios and the incremental cost-effectiveness ratio (ICER) were calculated to assess for cost-effectiveness using a threshold of $100,000/QALY gained.
  
  
  RESULTS
  The 1-year cost-utility ratio (total cost/ΔQALY) for the control cohort was significantly lower ($143,251/QALY gained) than that of the rhBMP-2 cohort ($272,414/QALY gained) (P<0.01). At 1-year follow-up, the control group dominated the ICER compared with the rhBMP-2 group.
  
  
  CONCLUSIONS
  Statistically significant and clinically relevant improvements (through minimum clinically important differences) were seen for both cohorts. In the ICER analysis, the control cohort dominated the rhBMP-2 group. Assuming durable per year gains in QALY, by 2 years fusion with autograft but without rhBMP-2 would be considered cost-effective ($71,625/QALY gained), whereas fusion with both autograft and rhBMP-2 would not be cost-effective ($136,207/QALY gained).
authors.affiliation: *Cleveland Clinic Center for Spine Health, Cleveland Clinic†Case Western Reserve University School of Medicine‡Cleveland Clinic Lerner College of Medicine, Cleveland, OH§Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA∥Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Alvin
authors.forename: Adeeb
authors.initials: A
authors.lastname: Derakhshan
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.forename: Kalil G
authors.initials: KG
authors.lastname: Abdullah
authors.forename: Robert G
authors.initials: RG
authors.lastname: Whitmore
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
mesh_terms: D055396:Bone Morphogenetic Protein 2 / Q000008:administration & dosage*; D016025:Bone Transplantation / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010147:Pain Measurement; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics*; D011795:Surveys and Questionnaires
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2