Cost-Effectiveness of Peptide Enhanced Bone Graft i-Factor versus Use of Local Autologous Bone in Anterior Cervical Discectomy and Fusion Surgery

Bart Thaci; Randy Yee; Kee Kim; Amir Vokshoor; J Patrick Johnson; Jared Ament

doi:10.2147/CEOR.S318589

Cost-Effectiveness of Peptide Enhanced Bone Graft i-Factor versus Use of Local Autologous Bone in Anterior Cervical Discectomy and Fusion Surgery

Clinicoecon Outcomes Res. 2021 Jul 24:13:681-691. doi: 10.2147/CEOR.S318589. eCollection 2021.

Authors

Bart Thaci¹, Randy Yee², Kee Kim¹, Amir Vokshoor^{2

3

4}, J Patrick Johnson⁵, Jared Ament^{2

3

4

5}

Affiliations

¹ University of California, Davis, Sacramento, CA, USA.
² Neuronomics LLC, Los Angeles, CA, USA.
³ Neurosurgery & Spine Group, Los Angeles, CA, USA.
⁴ Institute of Neuro Innovation, Santa Monica, CA, USA.
⁵ Cedars Sinai Medical Center, Los Angeles, CA, USA.

Abstract

Study design: We conducted decision analytical modeling using a Markov model to determine the ICER of i-factor compared to autograft in ACDF surgery.

Objective: The efficacy and safety of traditional anterior cervical discectomy and fusion (ACDF) surgery has improved with the introduction of new implants and compounds. Cost-effectiveness of these innovations remains an often-overlooked aspect of this effort. To evaluate the cost-effectiveness of i-FACTOR compared to autograft for patients undergoing ACDF surgery.

Methods: The patient cohort was extracted from a prospective, multicenter randomized control trial (RCT) from twenty-two North American centers. Patients randomly received either autograft (N = 154) or i-Factor (N = 165). We analyzed various real-world scenarios, including inpatient and outpatient surgical settings as well as private versus public insurances. Two primary outcome measures were assessed: cost and utility. In the base-case analysis, both health and societal system costs were evaluated. Health-related utility outcome was expressed in quality-adjusted life years (QALYs). Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER).

Results: In all scenarios, i-FACTOR reduced costs within the first year by 1.4% to 2.1%. The savings proved to be incremental over time, increasing to 3.7% over an extrapolated 10 years. The ICER at 90 days was $13,333 per QALY and became negative ("dominated") relative to the control group within one year and onwards. In a threshold sensitivity analysis, the cost of i-FACTOR could theoretically be increased 70-fold and still remain cost-effective.

Conclusion: The novel i-FACTOR is not only cost-effective compared to autograft in ACDF surgery but is the dominant economic strategy.

Keywords: anterior cervical discectomy and fusion; cervical spondylosis; cost analysis; cost-effectiveness; decision analysis; i-factor; spine allograft; spine fusion.