Economic evaluation of bone morphogenetic protein versus autogenous iliac crest bone graft in single-level anterior lumbar fusion: An evidence-based modeling approach

Study Design. Economic evaluation provides a framework to explicitly measure and compare the value of alternative medical interventions in terms of their clinical, health-related quality-of-life, and economic outcomes. Computerized economic models can help inform the design of future prospective studies by identifying the cost-drivers, the most uncertain parameter estimates, and the parameters with the greatest impact on the results and inferences. Objective. An economic analysis of bone morphogenetic protein versus autogenous iliac crest bone graft for single-level anterior lumbar fusion poses several methodologic challenges. This article describes how such an economic evaluation may be framed and designed, while enumerating challenges, offering some solutions, and suggesting an agenda for future research. Summary of Background Data. An evidence-based modeling approach can incorporate epidemiologic, clinical, and economic data from several sources including randomized clinical trials, peer-reviewed literature, and expert opinion. Sensitivity analyses can be conducted by varying key parameter estimates within a reasonable range to assess the impact on the results and inferences. Results. Preliminary results suggest that from a payer perspective, the upfront price of bone morphogenetic protein is likely to be entirely offset by reductions in the use of other medical resources. That is, bone morphogenetic protein appears to be cost neutral. The cost offsets were attributable largely to prevention of pain and complications associated with autogenous iliac crest bone graft, as well as reduction of the costs associated with fusion failures. Conclusions. Future research should focus on quantifying the health-related quality-of-life impact of bone morphogenetic protein relative to autogenous iliac crest bone graft, as well as the impact on lost productivity.