Spine - 2026-05-15 - Journal Article; Randomized Controlled Trial; Comparative Study
Cost-Effectiveness of ABM/P-15 Versus Allograft in Degenerative Spondylolisthesis Surgery : Ten-Year Follow-Up on a Randomized Controlled Trial.
Andresen AK, Carreon LY, Andersen MØ, Nielsen L, Sørensen J
Topics
Key Takeaway
ABM/P-15 as bone graft extender in uninstrumented posterolateral fusion for degenerative spondylolisthesis reduced 10-year reoperation rate to 18% versus 43% with allograft (P=0.024), achieving cost dominance.
Summary Depth
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Summary
This RCT-based cost-effectiveness analysis compared ABM/P-15 versus allograft as bone graft extender in uninstrumented posterolateral fusion for elderly patients with degenerative spondylolisthesis and stenosis. QALY gain favored ABM/P-15 by 0.42 points (95% CI -0.17 to 1.08, P=0.185), which was non-significant, but ABM/P-15 patients incurred 20% lower total healthcare costs driven by a significantly lower reoperation rate (18% vs. 43%, P=0.024). ABM/P-15 achieved economic dominance over allograft by simultaneously improving outcomes and reducing costs at 10 years.
Key Limitation
The QALY difference between groups did not reach statistical significance (P=0.185), meaning the clinical outcome superiority of ABM/P-15 remains unproven despite its economic dominance.
Original Abstract
STUDY DESIGN
Randomized controlled trial.
OBJECTIVE
The aim of this study was to investigate whether ABM/P-15 was cost-effective compared with allograft as a bone graft extender for uninstrumented posterolateral fusion for degenerative spondylolisthesis with spinal stenosis in elderly patients.
SUMMARY OF BACKGROUND DATA
In an increasingly elderly population with higher expectations of good health and quality of life, the need for durable surgery with minor risks of implant-related reoperations is growing. Specifically for lumbar fusion surgery, the need for a reliable bone graft material with acceptable fusion rates and low graft-related morbidity and risk of reoperation is important.
METHODS
This cost-effectiveness analysis was based on a single-center, blinded, randomized controlled trial, where patients with symptomatic degenerative spondylolisthesis were randomly assigned 1:1 to either ABM/P-15 or Allograft as bone graft material in uninstrumented posterolateral fusion. Quality-adjusted life years (QALY) were obtained from EQ-5D-3L. Use of health services was obtained from patient charts, costed and accumulated up to 10 years after index surgery.
RESULTS
The study included 101 patients with no inter-group differences in preoperative characteristics. On the basis of a bootstrapped analysis, the estimated the mean QALY gain for the ABM/P-15 group was 0.42 points (95% CI [-0.17; 1.08], P =0.185) greater compared with the Allograft group. Compared with the Allograft group, patients in the ABM/P-15 group had 20% less costs due to a significantly lower reoperation rate (18% vs. 43%, P =0.024), fewer visits to the outpatient clinic, magnetic resonance images, and fewer days of hospitalization.
CONCLUSIONS
The choice of bone graft material significantly affected cost-effectiveness of posterolateral lumbar fusion in elderly patients with degenerative spondylolisthesis at 10-year follow-up. ABM/P-15 showed dominance over Allograft with improved outcomes, lower health care costs, and lower reoperation rate.