Economic considerations for the use of recombinant human bone morphogenetic protein-2 in open tibial fractures in Europe: The German model

The addition of recombinant human bone morphogenetic protein (rhBMP-2) to the standard of care, consisting of soft tissue management and intramedullary nailing, in the BMP-2 Evaluation in Surgery for Tibial Trauma (BESTT) study led to a significantly better outcome for the patient. Reductions in fracture healing time, secondary interventions for delayed fracture healing and infection rates were observed with 1.50mg/mL rhBMP-2 compared with the standard of care alone. In Germany the approximate cost of applying one dose of recombinant human bone morphogenetic protein-2 (rhBMP-2) to an open tibial fracture is EURO2970. The current German-Diagnosis-Related Group reimbursement system provides one flat rate per hospital stay or treatment case, and does not take into account the costs of rhBMP-2 application. Therefore there is no reimbursement for the price of rhBMIP-2 for hospitals by health insurance companies. However, the above mentioned improvements in medical outcome could lead to important savings for health care systems, particularly for health insurance companies. A sound economic model to assess the cost-effectiveness and budget impact of rhBMP-2 is required. Using medical data from the BESTT study the differences in fracture healing time, in reduction of secondary interventions for fracture healing and infection treatment can be transferred into economic savings. It is anticipated that the overall savings that can be achieved by rhBMP-2 treatment in open tibia fractures, offset the upfront price of rhBMP-2 and lead to net savings for health insurance companies.