A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7

The parameter of health economics in the use of any contemporary medical module plays a dominant role in decision making. A prospective nonrandomised comparative study of the direct medical costs on the first attempt of treating aseptic nonunions of tibial fractures, with either autologous-iliac-crest-bone-graft (ICBG) or bone morphogenetic protein-7 (BMP-7), is presented. Twenty-seven consecutive patients, who were successfully treated for fracture nonunions, were divided into two groups. Group 1 (n = 12) received ICBG and group 2 (n = 15) received BMP-7. All patients healed their nonunions, and the financial analysis presented represents a best-case scenario. Three out of 12 of the ICBG group required revision surgery while just one out of 15 required it in the BMP-7 group. Average hospital stay was 10.66 vs. 8.66 days, time-to-union 6.9 vs. 5.5 months, hospitals costs 2,133.6 pound vs. 1,733.33 pound, and theatre costs were 2,413.3 pound vs. 906.67 pound for the ICBG and BMP-7 groups, respectively. The BMP-7 cost was 3002.2 pound. Fixation-implant was 696.4 pound vs. 592.3 pound, radiology 570 pound vs. 270 pound, outpatient 495.8 pound vs. 223.33 pound, and other costs were 451.6 pound vs. 566.27 pound for the ICBG and BMP-7 groups, respectively. The average cost of treatment with BMP-7 was 6.78% higher (P=0.1) than with ICBG, and most of this (41.1%) was related to the actual price of the BMP-7. In addition to the satisfactory efficacy and safety of BMP-7 in comparison to the gold standard of ICBG, as documented in multiple studies, its cost effectiveness is advocated favourably in this analysis.