9, 11 Included patients were randomized preoperatively to receive the ACDF structural graft either packed with local autologous bone (n=154) or with i-FACTOR (n=165). Patient informed consent and Institutional Review Board authorization was not required for this study since the patient cohort was extracted from a published prospective, multicenter randomized control trial (RCT). The purpose of this study was to perform a CEA via decision analytical modeling using a Markov method to evaluate the cost-effectiveness of i-FACTOR compared to autograft for patients receiving ACDF surgery. 10 A major drawback of the cost-accounting approach is its inability to describe relationships between clinical events, which impedes the prediction of how parameters change relative to one another. Two approaches are commonly used to conduct a cost-effective analysis (CEA) in healthcare: simple incremental calculation or decision analytical modeling. Despite promising results, our healthcare system is constantly being taxed by a growing number of aging individuals and it remains critical that innovation be appropriately assessed for cost and sustainability. In a study, Arnold et al, 9 demonstrated i-FACTOR to be comparable to local autologous bone for fusion rates and statistically superior in overall clinical success in patients undergoing ACDF surgery. 6–8 Notably, i-FACTOR, unlike bone morphogenetic protein, does not induce ossification in soft tissues. Originally, this technology was approved by the FDA to promote bone formation in periodontal defects due to its properties to enhance cell proliferation, differentiation and osteogenesis. Recently, i-FACTOR ® Peptide Enhanced Bone Graft, a novel anorganic bone matrix (ABM) containing a synthetic 15 amino acid cell-binding peptide (P-15 peptide) has been proposed as an alternative. Efficacy and cost-effectiveness are the pillars on which we need to make our choices. The debate comparing autologous bone, allografts, stem cells, and the highly cited and now debarred bone morphogenetic proteins (BMPs) for cervical spinal fusion 4, 5 is prevalent in the medical literature and omnipresent at national and international academic conferences. In the last two decades there has been increasing interest in biological grafts, the properties of natural and synthetic substitutes, and how alternatives to the traditional iliac crest autologous graft harvest can be safely used to accelerate healing and fusion. ![]() The ACDF procedure was first described by Cloward 2 and Smith & Robinson 3 six decades ago using autologous iliac crest bone graft (ICBG) and a lot has changed since. 1 Current technological advances in biomaterials are shaping the future of surgical techniques. Anterior cervical discectomy and fusion (ACDF) interventions have doubled over the previous decades and this trend is likely to continue as the population ages. Cervical spondylosis is the most common cause of myelopathy and upper extremity radiculopathy.
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