%0 Journal Article
%T Developing a risk score to inform the use of rhBMP-2 in adult spinal deformity surgery.
%A Williamson TK
%A Onafowokan OO
%A Schoenfeld AJ
%A Robertson D
%A Owusu-Sarpong S
%A Lebovic J
%A Yung A
%A Fisher MR
%A Cottrill EJ
%A Diebo BG
%A Lafage R
%A Lafage V
%A Crutcher CL
%A Daniels AH
%A Passias PG
%J Spine Deform
%V 0
%N 0
%D 2024 Aug 11
%M 39127991
暂无%R 10.1007/s43390-024-00946-4
%X <B>BACKGROUND: </B>Recombinant human bone morphogenetic protein-2 (rhBMP-2) has not shown superior benefit overall in cost-effectiveness during adult spinal deformity (ASD) surgery.<BR><B>METHODS: </B>Retrospective PURPOSE: Generate a risk score for pseudarthrosis to inform the utilization of rhBMP-2, balancing costs against quality of life and complications.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.<BR><B>METHODS: </B>III.