12. Health care costs and characteristics of spinal fusion patients receiving concentrated bone marrow aspirate (BMAC), iliac crest autograft or bone morphogenic protein (BMP) therapy: a retrospective cohort study utilizing administrative claims

Abstract

BACKGROUND CONTEXT To aid in fusion, surgeons may choose to use a biologic or other grafting agent in posterior lumbar spinal fusion procedures. This study explored the differences in cost and a variety of outcomes of bone marrow aspirate concentrate (BMAC), iliac crest autogenous bone grafting (autograft) and recombinant human bone morphogenetic proteins (rhBMP) -2 and -7. Autograft complications include pain, risk of infection and donor morbidity. BMP drawbacks are high cost and at risk of stimulating too much bone growth. While BMAC has been shown to promote bone and soft tissue healing, possible risks include bleeding and infection or nerve damage. PURPOSE A market assessment was conducted to explore the clinical value of each product. The study also looked at patient demographics, outcomes, and cost across the grafting products. STUDY DESIGN/SETTING Retrospective administrative claims data from the Optum Commercial and Medicare Advantage affiliated claims dataset between January 1, 2016 and December 31, 2017. PATIENT SAMPLE The final study cohort consisted of 14,668 patients (BMAC: n=3,181; autograft: n=11,085; BMP: n=402) in the US. 84.5% (n=12,683) of patients had only 1 index procedure product and 97.2% (n=14,251) had a successful fusion. The majority of patients were aged 65+ (n=7,581 /52%), female (n=8,122 /55%), and received Medicare coverage (n=8,639 /59%). OUTCOME MEASURES Data on select patient demographic and clinical characteristic measures were collected, including Charlson Comorbidity Index (CCI) score and top AHRQ comorbidities. Inpatient and outpatient hospital costs, length of stay (LOS) and mean standardized cost per patient by procedure were among the data collected to drive the cost analysis. METHODS Patients with >= 1 a CPT code for a procedure of interest for autograft or BMAC or an ICD-10-PCS code for BMP of interest were identified during the study time period. Patients were indexed at admission date of MS-DRG involving first observed instance of a procedure of interest and required to have 6 months pre-and 12 months post-index continuous medical and pharmacy coverage. Data were analyzed using descriptive statistics. The mean differences in costs were assessed using Student's t-test for statistical significance. RESULTS The average length of stay (BMAC=3.6 days; autograft=3.8 days; BMP=4.3 days [p-value: BMAC vs autograft= CONCLUSIONS Data from this study showcases the cost savings and potential impact on health outcomes which can be incurred through the implementation of BMAC as a biologic in treating spine fusion patients. Given the rising cost of spinal fusion procedures performed annually in the US, further research should focus on evaluating the cost-effectiveness of the various procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.