A study recently published in Spine examines whether using femoral heads from patients undergoing total hip arthroplasty for spinal fusion as a source of allograft bone is cost-effective.
While bone graft substitutes are costly and harvesting iliac crest bone autograft could be associated with higher morbidity, researchers examined whether femoral heads harvested under sterile conditions during total hip arthroplasty could be frozen and used as a source of allograft bone during spinal fusion. Here are five things to know about the study:
1. The average cost of femoral head allograft is $435 for processing the tissue, resulting in $8.70 per cubic centimeter of allograft produced. The average femoral head allograft is 54 mm to 56 mm in diameter and yields 50 cubic centimeters of bone graft. "Femoral head allograft is a cost-effective alternative to commercially available allografts and bone substitutes," concluded the study authors. "The method of procurement, storage and use described could be adopted by other institutions in an effort to mitigate cost and increase supply."
2. The average costs for producing femoral head allograft is significantly lower than producing commonly available commercial bone graft substitutes. The average bone substitute cost was $60 to $178 per cubic centimeter, according to the study, and demineralized bone matrix cost $72.60 to $217 per cubic centimeter.
3. The product has a two-year shelf life. "At such low cost and relative abundance, due to the frequency of THA procedures at most major hospitals, this maybe a reasonable technique to provide bone graft for use in spinal arthrodesis and other procedures requiring the use of allograft bone," the study authors said. "In contrast, the start-up costs for smaller hospitals or private centers lacking pre-existing infrastructure and high-volume orthopedic practice may be prohibitive."
4. The United States is the biggest player in the global spinal fusion market, but its growth will drop 8 percent over the next six years due to increased regulation and reimbursement pressures, according to a Research and Markets report. The global spinal fusion market was valued at $4.7 billion last year and is expected to reach $6.9 billion by 2020.
5. There is more emphasis placed on cost-effective care today than in the past and for patients who would benefit from surgery, there are a few factors surgeons can control to lower the cost of care. Minimally invasive procedures generally cost less than open procedures because for a seasoned surgeon; there is less time in the operating room — which also means less time under anesthesia; less blood loss — possibility eliminating blood transfusion needs; less pain; earlier mobility; and fewer days in the hospital postoperatively.
Some patients are now undergoing outpatient spine surgery, drastically reducing the high costs associated with hospital stays. This makes a huge impact on spine surgery, as fixed costs such as hospitalization, nursing, physical therapy, imaging and postoperative care can amount to 55 percent to 60 percent of total costs by some estimates. Implant and materials costs are also a big factor, ranging from 20 percent to 25 percent of overall costs.
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