RhBMP-2 Versus Iliac Crest Bone Graft for Lumbar Spine Fusion in Patients Over 60 Years of Age

作者：Leah Y. Carreon, Steven D. Glassman, Mladen Djurasovic, Mitchell J. Campbell, Rolando M. Puno, John R. Johnson, John R. Dimar · 发表于：Spine · 年份：2009 · DOI：10.1097/brs.0b013e31818ffabe · 被引用次数：93 · 研究领域：Spine and Intervertebral Disc Pathology、Cervical and Thoracic Myelopathy、Bone health and osteoporosis research

STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To perform a cost-utility analysis using actual cost data from a randomized clinical trial of patients over 60 years old who underwent posterolateral fusion using either rhBMP-2/ACS or iliac crest bone graft (ICBG). SUMMARY BACKGROUND DATA: Bone morphogenetic protein has been shown to be an effective bone graft substitute for spine fusion. However, a clinical trial-based economic analysis of rhBMP-2/ACS compared with iliac crest bone graft has not been done. METHODS: Patients over 60 years old requiring decompression and posterolateral fusion were randomized to rhBMP-2/ACS (n = 50) or ICBG (n = 52). A dedicated hospital coder and research nurse tracked each patient to determine direct costs of inpatient care and all postoperative healthcare encounters up to 2 years after surgery. Preoperative and 2-year-postoperative SF-6D utility scores for each patient were determined. A decision tree was created, which included the probability of complications, need for additional treatments and revision surgery; and the costs associated with initial surgery and treatment for complications and additional treatment for continued spine symptoms; and utility scores. RESULTS: The mean total 2-year cost for care (excluding complication and additional spine treatment costs) was $34,235 in the ICBG group and $36,530 in the rhBMP-2/ACS group. For the entire group, the mean cost to treat a major complication was $10,888, the cost of revision surge...