An Economic Analysis of BMP for Fusion

· (a – Medtronic Sofamor Danek)

PURPOSE: An economic model was developed to compare costs of bone morphogenetic protein (BMP) versus autogenous iliac crest bone graft (AICBG) for spinal fusion. Fusion and complication rates were based on two multi-center, randomized, clinical trials comparing stand-alone anterior lumbar interbody fusion with BMP (recombinant human bone morphogenetic protein 2 [rhBMP-2]) on an absorbable collagen sponge vs. AICBG in either a tapered cylindrical cage (LT-CAGE™ clinical trial) or a threaded cortical bone dowel (Bone Dowel clinical trial). The objective of this study was to determine the effect of use of BMP on the process of care and costs of spinal fusion during the index hospitalization and in the subsequent two years. The economic model was developed based on data from clinical trials, peer-reviewed literature, and expert opinion.

METHODS: We identified and assigned costs to medical resources that would increase or decrease with the use of BMP. Direct medical costs in two distinct contexts were considered: those incurred by the hospital during the index hospitalization and those incurred during both the index hospitalization and two years afterwards. The price of BMP in the base case analyses was $3,380. The costs are reported in 2001 U.S. dollars.

RESULTS: In the base case analysis over a period of two years, total direct medical costs for spinal fusion were similar for BMP and AICBG ($9 difference favoring BMP) using clinical trial fusion rates of 94.5% and 88.7%, respectively (LT-CAGE™ clinical trial). In a sensitivity analysis over a period of two years using fusion rates of 100% for rhBMP-2 and 68.4% for AICBG, respectively (Bone Dowel clinical trial), BMP resulted in $4,564 in savings. In the base case analysis from a hospital perspective (index hospitalization only), nearly half of the $3,380 price of BMP was offset.

CONCLUSION: The upfront price of BMP is likely to be offset to a significant extent by reductions in the use of other medical resources, particularly if costs incurred during the two-year period following the index hospitalization are taken into account.

· If noted, the author indicates something of value received. The codes are identified as: a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options.