FP3.4 The Potential of Bone Marrow Aspirate Concentrate to be a Cost-Effective Treatment in Preventing Conversion to Total Hip Arthroplasty

Background: To investigate if bone marrow aspirate concentrate (BMAC) is an efficacious and cost-effective adjuvant therapy for preventing long-term conversion to total hip arthroplasty (THA).

Methods: This study queried patients who underwent arthroscopic repair of symptomatic acetabular labral tears secondary to femoroacetabular impingement (FAI). Patients between 18 and 50 years old with minimum 2-year follow-up and Tönnis grade 0 or 1 were included. The study population was divided into cohorts (BMAC vs. No BMAC) according to BMAC augmentation at the time of labral repair. The study’s survival endpoint was the longest follow-up timepoint completed by a BMAC patient; “failure” was defined as conversion to THA. A weighted Cox regression estimated BMAC’s efficacy for improving hip arthroscopy survivorship. BMAC cost-effectiveness was measured by comparing quality-adjusted life-years (QALY) gained using Kaplan Meier survival analysis. At an estimated institutional cost of $10,000, BMAC was considered cost-effective if its incremental cost-effectiveness ratio (ICER) was below a threshold of $50,000.

Results: Overall, 359 patients (BMAC: 124 [34.5%] vs No BMAC: 235 [65.5%]) met inclusion criteria. Besides sex and FAI-type, there were no differences between cohorts. Within 6.2 years, a significantly greater proportion of No BMAC patients underwent THA (14 [5.96%] vs 1 [0.81%]; P=.020). Although not statistically different, a weighted cox regression controlling for sex and FAI type suggests that BMAC augmentation reduces the risk of converting to THA by 77% (P=.163). According to the Kaplan Meier survival analysis, BMAC patients had a greater QALY (6.13 vs. 5.99). At a cost of $10,000, however, BMAC had an ICER of $76,228.77 and was not considered cost-effective. Re-arranging the ICER equation and maintaining the 0.14 QALY-gained, BMAC must cost less than $6,559.20 to be considered a cost-effective treatment for preventing THA.

Discussion/Conclusions: According to the present study, BMAC must cost less than $6,559.20 to be considered a cost-effective treatment for improving long-term hip arthroscopy survivorship.