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RhBMP-2 can lower overall adult idiopathic scoliosis surgery costs

Overall treatment costs were lower if rates of pseudarthrosis remained less than 4.5%.

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Using bone morphogenic protein-2 to treat adult idiopathic scoliosis typically increases surgery costs, yet it can cut the overall cost-per-patient in a group by reducing the pseudarthrosis reoperation rate, researchers have found.

The bone protein is known to increase spinal fusion rates and surgery costs. However, it may yield cost savings if the reoperation rate for pseudarthrosis is relatively low, said Lawrence Lenke, MD, discussing his and co-authors’ findings in a special poster presentation at the 2005 Annual Congress of the Spine Society of Europe (EuroSpine 2005).

“Reoperation to repair pseudarthrosis is also costly; however, it must be considered in overall expense-estimation,” the authors wrote in the abstract. “The use of rhBMP-2 may be cost-saving if the rate of reoperation for pseudarthrosis (17% in our latest series) is reduced.”

Surgery with and without rhBMP-2

The researchers did the study intending to examine the relative costs of doing initial surgery for adult idiopathic scoliosis with and without recombinant human bone morphogenetic protein-2 (rhBMP-2). The retrospective study included patients who underwent posterior surgery for adult idiopathic scoliosis at one institution between 2000 and 2004.

The first group comprised 23 patients who had primary surgery without rhBMP-2. The second group, made up of 24 patients, had the surgery with the protein. A third group, of 19 patients, had revision surgery with rhBMP-2 for pseudarthrosis after adult deformity surgery at the same time.

“Interval charges for each hospitalization for all patients were obtained and converted to estimated costs using the ratio of costs-to-charges method,” the authors said in the abstract. “All costs were converted to 2002 dollars using the health care component of the Consumer Price Index.”

Costs varied

The groups’ hospitalization costs varied widely. The first group’s median hospitalization cost was $41,000. The second group’s median hospitalization cost totaled $49,500. The third group’s median hospitalization cost amounted to $67,300.

The adjusted, estimated cost-per-patient of primary surgery without rhBMP-2 (and a 0.17 probability of reoperation because of pseudarthrosis, based on an earlier study without BMP) was $52,500. A “threshold analysis” showed that using rhBMP-2 at the time of index surgery may reduce surgical cost if the pseudarthrosis rate is under 4.5%.

Dr. Lenke is a paid consultant for Medtronic Sofamor Danek.

For more information:

• Lenke LG, Angevine PD, Stobbs G, Bridwell KH. Cost-offset analysis of bone morphogenic protein (rhBMP-2) in primary surgery for adult idiopathic scoliosis. SP1. Presented at EuroSpine 2005. Sept. 21-24, 2005. Barcelona, Spain.