Spine - 2026-03-06 - Journal Article
Cost-effectiveness of ABM/P-15 versus Allograft in Degenerative Spondylolisthesis Surgery: 10-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 with 20% lower total healthcare costs.
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Summary
This single-center RCT-based cost-effectiveness analysis compared ABM/P-15 versus allograft as bone graft extenders in uninstrumented posterolateral fusion for elderly patients with degenerative spondylolisthesis and stenosis. At 10 years, ABM/P-15 patients had a reoperation rate of 18% versus 43% for allograft (P=0.024), 20% lower total healthcare costs, and a non-significant mean QALY gain of 0.42 (95% CI -0.17 to 1.08, P=0.185). ABM/P-15 achieved economic dominance over allograft driven primarily by reduced reoperations, outpatient visits, imaging, and hospitalization days.
Key Limitation
Single-center design with 101 patients limits generalizability, and the non-significant QALY difference means dominance is driven entirely by cost reduction rather than demonstrated superior patient-reported outcomes.
Original Abstract
STUDY DESIGN
Randomized controlled trial.
OBJECTIVE
The aim of this study was to investigate whether ABM/P-15 was cost-effective compared to allograft as a bone graft extender for un-instrumented 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 un-instrumented posterolateral fusion. Quality-Adjusted Life Years (QALY) were obtained from EQ-5D-3L. Use of health services were obtained from patient charts, costed and accumulated up to ten years after index surgery.
RESULTS
The study included 101 patients with no inter-group differences in preoperative characteristics. Based on 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 to the Allograft group. Compared to 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.
CONCLUSION
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 healthcare costs and lower re-operation rate.