Abstract：
BACKGROUND: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has not shown superior benefit overall in cost-effectiveness during adult spinal deformity (ASD) surgery.
METHODS: Retrospective PURPOSE: Generate a risk score for pseudarthrosis to inform the utilization of rhBMP-2, balancing costs against quality of life and complications.
METHODS: ASD patients with 3-year data were included. Quality of life gained was calculated from ODI to SF-6D and translated to quality-adjusted life years (QALYs). Cost was calculated using the PearlDiver database and CMS definitions for complications and comorbidities. Established weights were generated for predictive variables via logistic regression to yield a predictive risk score for pseudarthrosis that accounted for frailty, diabetes, depression, ASA grade, thoracolumbar kyphosis and three-column osteotomy use. Risk score categories, established via conditional inference tree (CIT)-derived thresholds were tested for cost-utility of rhBMP-2 usage, controlling for age, prior fusion, and baseline deformity and disability.
RESULTS: 64% of ASD patients received rhBMP-2 (308/481). There were 17 (3.5%) patients that developed pseudarthrosis. rhBMP-2 use overall did not lower pseudarthrosis rates (OR: 0.5, [0.2-1.3]). Pseudarthrosis rates for each risk category were: No Risk (NoR) 0%; Low-Risk (LowR) 1.6%; Moderate Risk (ModR) 9.3%; High-Risk (HighR) 24.3%. Patients receiving rhBMP-2 had similar QALYs overall to those that did not (0.163 vs. 0.171, p = .65). rhBMP-2 usage had worse cost-utility in the LowR cohort (p < .001). In ModR patients, rhBMP-2 usage had equivocal cost-utility ($53,398 vs. $61,581, p = .232). In the HighR cohort, the cost-utility was reduced via rhBMP-2 usage ($98,328 vs. $211,091, p < .001).
CONCLUSIONS: Our study shows rhBMP-2 demonstrates effective cost-utility for individuals at high risk for developing pseudarthrosis. The generated score can aid spine surgeons in the assessment of risk and enhance justification for the strategic use of rhBMP-2 in the appropriate clinical contexts.
METHODS: III.
METHODS: Retrospective PURPOSE: Generate a risk score for pseudarthrosis to inform the utilization of rhBMP-2, balancing costs against quality of life and complications.
METHODS: ASD patients with 3-year data were included. Quality of life gained was calculated from ODI to SF-6D and translated to quality-adjusted life years (QALYs). Cost was calculated using the PearlDiver database and CMS definitions for complications and comorbidities. Established weights were generated for predictive variables via logistic regression to yield a predictive risk score for pseudarthrosis that accounted for frailty, diabetes, depression, ASA grade, thoracolumbar kyphosis and three-column osteotomy use. Risk score categories, established via conditional inference tree (CIT)-derived thresholds were tested for cost-utility of rhBMP-2 usage, controlling for age, prior fusion, and baseline deformity and disability.
RESULTS: 64% of ASD patients received rhBMP-2 (308/481). There were 17 (3.5%) patients that developed pseudarthrosis. rhBMP-2 use overall did not lower pseudarthrosis rates (OR: 0.5, [0.2-1.3]). Pseudarthrosis rates for each risk category were: No Risk (NoR) 0%; Low-Risk (LowR) 1.6%; Moderate Risk (ModR) 9.3%; High-Risk (HighR) 24.3%. Patients receiving rhBMP-2 had similar QALYs overall to those that did not (0.163 vs. 0.171, p = .65). rhBMP-2 usage had worse cost-utility in the LowR cohort (p < .001). In ModR patients, rhBMP-2 usage had equivocal cost-utility ($53,398 vs. $61,581, p = .232). In the HighR cohort, the cost-utility was reduced via rhBMP-2 usage ($98,328 vs. $211,091, p < .001).
CONCLUSIONS: Our study shows rhBMP-2 demonstrates effective cost-utility for individuals at high risk for developing pseudarthrosis. The generated score can aid spine surgeons in the assessment of risk and enhance justification for the strategic use of rhBMP-2 in the appropriate clinical contexts.
METHODS: III.
摘要：
背景：重组人骨形态发生蛋白-2（rhBMP-2）在成人脊柱畸形（ASD）手术的总体成本效益方面并未显示出优异的优势。
方法：回顾性目的：生成假关节风险评分，以告知rhBMP-2的使用情况，平衡成本与生活质量和并发症。
方法：纳入ASD患者的3年数据。从ODI到SF-6D计算获得的生活质量，并转化为质量调整寿命年(QALYs)。使用PearlDiver数据库和CMS定义的并发症和合并症计算成本。通过逻辑回归为预测变量生成已建立的权重，以产生可解释虚弱的假关节的预测风险评分。糖尿病,抑郁症,ASA等级,胸腰椎后凸和三柱截骨术的使用。风险评分类别,通过条件推理树(CIT)导出的阈值对rhBMP-2使用的成本效用进行了测试，控制年龄，先前的融合，基线畸形和残疾。
结果：64%的ASD患者接受rhBMP-2(308/481)。有17例（3.5％）患者发生假关节。rhBMP-2的使用并没有降低假关节的发生率(OR:0.5,[0.2-1.3]).每个风险类别的假关节发生率为：无风险（NoR）0％；低风险（LowR）1.6％；中等风险（ModR）9.3％；高风险（HighR）24.3％。接受rhBMP-2的患者总体QALYs与未接受rhBMP-2的患者相似（0.163vs.0.171，p=.65）。在LowR队列中，rhBMP-2的使用成本效用更差(p<.001)。在ModR患者中，rhBMP-2的使用具有模棱两可的成本效用（53,398美元与61,581美元，p=.232）。在HighR队列中，通过使用rhBMP-2降低了成本效用(98,328美元与211,091美元，p<.001）。
结论：我们的研究表明，rhBMP-2对发生假关节的高危个体具有有效的成本效用。生成的评分可以帮助脊柱外科医生评估风险，并增强在适当的临床环境中战略使用rhBMP-2的合理性。
方法：III.
方法：回顾性目的：生成假关节风险评分，以告知rhBMP-2的使用情况，平衡成本与生活质量和并发症。
方法：纳入ASD患者的3年数据。从ODI到SF-6D计算获得的生活质量，并转化为质量调整寿命年(QALYs)。使用PearlDiver数据库和CMS定义的并发症和合并症计算成本。通过逻辑回归为预测变量生成已建立的权重，以产生可解释虚弱的假关节的预测风险评分。糖尿病,抑郁症,ASA等级,胸腰椎后凸和三柱截骨术的使用。风险评分类别,通过条件推理树(CIT)导出的阈值对rhBMP-2使用的成本效用进行了测试，控制年龄，先前的融合，基线畸形和残疾。
结果：64%的ASD患者接受rhBMP-2(308/481)。有17例（3.5％）患者发生假关节。rhBMP-2的使用并没有降低假关节的发生率(OR:0.5,[0.2-1.3]).每个风险类别的假关节发生率为：无风险（NoR）0％；低风险（LowR）1.6％；中等风险（ModR）9.3％；高风险（HighR）24.3％。接受rhBMP-2的患者总体QALYs与未接受rhBMP-2的患者相似（0.163vs.0.171，p=.65）。在LowR队列中，rhBMP-2的使用成本效用更差(p<.001)。在ModR患者中，rhBMP-2的使用具有模棱两可的成本效用（53,398美元与61,581美元，p=.232）。在HighR队列中，通过使用rhBMP-2降低了成本效用(98,328美元与211,091美元，p<.001）。
结论：我们的研究表明，rhBMP-2对发生假关节的高危个体具有有效的成本效用。生成的评分可以帮助脊柱外科医生评估风险，并增强在适当的临床环境中战略使用rhBMP-2的合理性。
方法：III.
