Lloyd Adam P
New Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Clin Spine Surg. 2017 Jul;30(6):E720-E724. doi: 10.1097/BSD.0000000000000273.
A retrospective cohort study.
To investigate the unknown direct costs of failed instrumented lumbar fusion using iliac crest bone graft (ICBG) and subsequent reoperation utilizing recombinant human bone morphogenetic protein-2 (rhBMP-2) from a primary payer perspective.
Recent evidence has demonstrated increased rates of instrumented lumbar fusion and utilization of rhBMP-2 to treat a range of conditions causing lower back pain. For health care providers with finite financial resources, there is an increasing demand to evaluate economic costs of available treatment modalities. The high cost of rhBMP-2 has often been cited as a leading reason for delaying its universal acceptance as a preferred substitute to ICBG. It has been hypothesized that rhBMP-2 may demonstrate cost-effectiveness if pseudarthrosis and reoperation rates are decreased, thus avoiding subsequent expenditure.
This was a retrospective cohort study of patients who underwent instrumented lumbar fusions utilizing rhBMP-2. Hospital finance records were used to calculate direct total expenditure incurred by the primary payer for the procedure using rhBMP-2. For patients who received rhBMP-2 in a secondary lumbar fusion, additional total expenditure related to the patients' failed primary instrumented fusion with ICBG was also sought.
The mean total costs associated with failed instrumented lumbar fusion using ICBG and reoperation using rhBMP-2 totaled £47,734 per patient. The total direct costs of a policy of primary instrumented lumbar fusion with rhBMP-2 were less at £26,923 per patient; however, this was not significant.
To date, this is the first study to report the costs of failed primary instrumented lumbar fusions using ICBG and subsequent secondary fusions using rhBMP-2 from a primary payer perspective. On the basis of this evidence, a policy of using rhBMP-2 in all patients undergoing a primary instrumented lumbar fusion cannot be recommended.
一项回顾性队列研究。
从主要支付方的角度，调查使用髂嵴骨移植（ICBG）的腰椎融合内固定失败后的未知直接成本，以及随后使用重组人骨形态发生蛋白-2（rhBMP-2）进行再次手术的成本。
最近的证据表明，腰椎融合内固定的发生率以及使用rhBMP-2治疗一系列导致腰痛的疾病的情况有所增加。对于资金有限的医疗保健提供者来说，评估现有治疗方式的经济成本的需求日益增加。rhBMP-2的高成本经常被认为是其未能被普遍接受作为ICBG首选替代品的主要原因。据推测，如果假关节形成率和再次手术率降低，从而避免后续支出，rhBMP-2可能会显示出成本效益。
这是一项对接受rhBMP-2腰椎融合内固定手术患者的回顾性队列研究。利用医院财务记录计算主要支付方为使用rhBMP-2的手术所产生的直接总支出。对于在二次腰椎融合中接受rhBMP-2治疗的患者，还需查找与患者初次ICBG腰椎融合内固定失败相关的额外总支出。
使用ICBG的腰椎融合内固定失败以及使用rhBMP-2进行再次手术，每位患者的平均总成本总计47,734英镑。采用rhBMP-2进行初次腰椎融合内固定的政策，其直接总成本较低，每位患者为26,923英镑；然而，这并不显著。
迄今为止，这是第一项从主要支付方角度报告使用ICBG的初次腰椎融合内固定失败以及随后使用rhBMP-2进行二次融合的成本的研究。基于这一证据，不建议对所有接受初次腰椎融合内固定手术的患者使用rhBMP-2的政策。
