Glassman Steven D, Carreon Leah Y, Campbell Mitchell J, Johnson John R, Puno Rolando M, Djurasovic Mladen, Dimar John R
Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Spine J. 2008 May-Jun;8(3):443-8. doi: 10.1016/j.spinee.2007.03.004. Epub 2007 May 15.
There is mounting evidence supporting the efficacy of bone morphogenetic protein (BMP) for both anterior interbody and posterolateral lumbar fusion. However, the relative cost of BMP remains an important concern for physicians, hospitals, and payers.
The purpose of this study is to report on the perioperative costs for patients treated with rhBMP-2 as compared with an iliac crest bone graft (ICBG) supplemented with graft extenders.
STUDY DESIGN/SETTING: A prospective randomized controlled trial of rhBMP-2/ACS (Infuse Bone Graft; Medtronic Sofamor Danek, Memphis, TN) versus ICBG+/-graft extender for lumbar spine fusion in patients over 60 years old.
One hundred two patients over 60 years old who required a posterolateral lumbar spine fusion randomized between receiving rhBMP-2/ACS or ICBG.
All health-care costs over the first 3 months after surgery.
As part of a prospective randomized trial of rhBMP-2/ACS versus ICBG+/-graft extender for lumbar spine fusion, all costs over the first 3 months after surgery were directly recorded by a dedicated coder funded by Norton Healthcare, Louisville, KY. A dedicated research nurse also followed all patients throughout their hospital stay and posthospitalization recovery to identify any adverse events or additional outpatient medical care.
Fifty patients received rhBMP-2/ACS and 52 underwent ICBG harvest. The mean hospital cost for the index admission was $24,736 for the rhBMP-2/ACS group and $21,138 for the ICBG group. Mean inpatient physician costs were $5,082 in the rhBMP-2/ACS group and $5,316 in the ICBG group. Costs associated with posthospital rehabilitation averaged $4,906 in the rhBMP-2/ACS group versus $6,820 in the ICBG group. Total payer expenditure for the 3-month perioperative period averaged $33,860 in the rhBMP-2/ACS group and $37,227 in the ICBG group.
The hospital carries the cost burden associated with the utilization of rhBMP-2/ACS. In contrast, the payer in a Diagnosis-Related Group (DRG) model achieves a net savings, based primarily on the decreased payment for inpatient rehabilitation, but also on decreased hospital reimbursement, physician costs, and other outpatient services.
越来越多的证据支持骨形态发生蛋白（BMP）在前路椎间融合和腰椎后外侧融合中的疗效。然而，BMP的相对成本仍是医生、医院和付款方的重要关注点。
本研究旨在报告接受重组人骨形态发生蛋白-2（rhBMP-2）治疗的患者与接受添加植骨扩展剂的髂嵴骨移植（ICBG）患者的围手术期成本。
研究设计/地点：一项针对60岁以上患者的rhBMP-2/ACS（Infuse骨移植；美敦力索法玛丹纳公司，田纳西州孟菲斯）与ICBG+/-植骨扩展剂用于腰椎融合的前瞻性随机对照试验。
102例60岁以上需要进行腰椎后外侧融合的患者被随机分为接受rhBMP-2/ACS或ICBG治疗。
术后前3个月的所有医疗费用。
作为rhBMP-2/ACS与ICBG+/-植骨扩展剂用于腰椎融合的前瞻性随机试验的一部分，术后前3个月的所有费用由肯塔基州路易斯维尔市诺顿医疗保健公司资助的一名专业编码员直接记录。一名专业研究护士在患者住院期间及出院后康复过程中全程跟踪所有患者，以确定任何不良事件或额外的门诊医疗护理情况。
50例患者接受了rhBMP-2/ACS治疗，52例接受了ICBG采集。rhBMP-2/ACS组初次住院的平均医院成本为24,736美元，ICBG组为21,138美元。rhBMP-2/ACS组住院期间医生的平均成本为5,082美元，ICBG组为5,316美元。rhBMP-2/ACS组与出院后康复相关的成本平均为4,906美元，ICBG组为6,820美元。rhBMP-2/ACS组3个月围手术期付款方的总支出平均为33,860美元，ICBG组为37,227美元。
医院承担与使用rhBMP-2/ACS相关的成本负担。相比之下，在诊断相关分组（DRG）模式下，付款方实现了净节省，主要基于住院康复费用的减少，也基于医院报销、医生成本和其他门诊服务费用的减少。
