Costs and outcomes of recombinant human bone morphogenetic protein-2 (rhBMP-2) usage in single level posterior or transforaminal lumbar interbody fusion (TLIF) in a propensity score matched national, retrospective cohort
Abstract
BACKGROUND CONTEXT
Recombinant human bone morphogenetic protein-2 (rhBMP-2) is widely used in posterior or transforaminal lumbar interbody fusion (P/TLIF). While rhBMP-2 demonstrates comparable fusion rates to autologous iliac crest bone graft (AICBG), its high cost brings into question its long-term cost effectiveness. This question is particularly pertinent in single-level P/TLIF where AICBG achieves excellent fusion rates.
PURPOSE
To evaluate the costs associated with and clinical outcomes of rhBMP-2 versus non-rhBMP-2 usage in single-level P/TLIF using a propensity score-matched national sample.
STUDY DESIGN/SETTING
Retrospective propensity score-matched cohort study using the Premier Healthcare claims database (2016-2022).
PATIENT SAMPLE
National sample of 9,457 patients who underwent single-level P/TLIF with rhBMP-2 utilization who were one-to-one matched with 9,457 P/TLIF patients without rhBMP-2 based on demographics, Elixhauser comorbidities, and surgical indications.
OUTCOME MEASURES
Primary economic outcomes were index encounter costs by category, and 2-year cumulative post-discharge costs. Primary clinical outcomes were 90-day readmission and 2-year revision fusion incidence. Secondary clinical outcomes were 2-year revision decompression incidence, pseudoarthrosis, seroma, infection, and implant complications.
METHODS
Single level P/TLIF procedures were identified via billing codes for the procedure. rhBMP-2 usage was identified via identification in the itemized…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 9,457 participants or records.
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