Cost-effectiveness of 4 mg dibotermin alfa/absorbable collagen sponge versus iliac crest bone graft for lumbar degenerative disc disease in the United Kingdom

Figures & data

Table 1. Model input parameters and values.

Parameter	Mean (95% CI)	p-value	Source
Mixed-effects odds ratio for difference in proportion of patients requiring failure-related secondary surgery	0.55 (0.30, 1.01)	.055	IPD meta-analysis
Difference in change from baseline utility weight:
1.5 months	0.001 (−0.024, 0.026)	.936	IPD meta-analysis
3 months	0.014 (−0.013, 0.041)	.319	IPD meta-analysis
6 months	0.004 (−0.024, 0.032)	.804	IPD meta-analysis
12 months	−0.002 (−0.034, 0.03)	.903	IPD meta-analysis
24 months	0.012 (−0.021, 0.046)	.477	IPD meta-analysis
Difference in operating room time (hours)	−0.448 (−0.614, −0.282)	<.001	IPD meta-analysis
Difference in hospital length of stay (days)	−0.404 (−1.13, 0.321)	.275	IPD meta-analysis
Cost of dibotermin alfa/ACS − 4 mg pack	£1,045	–	Medtronic NHS acquisition cost
Cost per hospital bed day	£413	–	NHS reference costs 2017–18 [21]
Cost of failure-related second surgery	£12,224	–	NHS reference costs 2017–18 [21]
Cost of operating room use (per hour)	£1,220	–	NHS improvement, 2019 [22]
Patient salary (per 6 months)	£15,210	–	Office for national statistics [23]

All results from meta-analysis are for dibotermin alfa/ACS versus iliac crest bone graft. Abbreviations. ACS, absorbable collagen sponge; CI, confidence interval; ICBG, Iliac crest bone graft; IPD, individual patient data; NHS, National Health Service.

Table 2. Deterministic cost-effectiveness results (discounted).

Incremental cost (£)	Incremental QALYs	ICER
−192	0.0114	Dibotermin alfa/ACS dominates

Abbreviations. ACS, absorbable collagen sponge; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year.

Figure 1. Tornado diagram of one-way sensitivity analysis results. Abbreviations. ACS, absorbable collagen sponge; ICBG, iliac crest bone graft; QALY, quality-adjusted life-years.

Figure 2. Cost-effectiveness scatter plot. Abbreviation. QALYs, quality-adjusted life-years).

Figure 3. Cost-effectiveness acceptability curve. Abbreviations. ACS, absorbable collagen sponge; ICBG, iliac crest bone graft.