The expense for one implantation of a banked bone allograft from a cadaveric donor and the issues affecting current adva
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The expense for one implantation of a banked bone allograft from a cadaveric donor and the issues affecting current advanced medical treatment in the Japanese orthopaedic field Ken Urabe Æ Kouji Naruse Æ Masataka Uchino Æ Masashi Takaso Æ Mamoru Fujita Æ Katsufumi Uchiyama Æ Takamitsu Okada Æ Midori Kasahara Æ Moritoshi Itoman Received: 30 April 2008 / Accepted: 4 December 2008 / Published online: 9 January 2009 Ó Springer Science+Business Media B.V. 2009
Abstract Demand for banked bone allografts is increasing in Japan; however, there are too few bone banks and the bone bank network is not wellestablished. One reason for this was lack of funding for banks. Bone banks had to bear all material expenses of banked bone allografts themselves because this was not designated a covered expense. In December 2004, the Japanese government started a new ‘‘Advanced Medical Treatment’’ administration system which allowed an approved institution to charge the expense of authorized advanced medical treatments directly to patients. The treatment named ‘‘Cryopreserved allogenic bone and ligamentous tissue retrieved from cadaveric donor’’ was approved as an advanced medical treatment in March 2007. We present the calculation method and the expense per implantation of a banked bone allograft from a cadaveric donor under this treatment and raise issues which affect this advanced medical treatment and K. Urabe (&) K. Naruse M. Uchino M. Takaso M. Fujita K. Uchiyama T. Okada M. Itoman Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan e-mail: [email protected] K. Urabe K. Naruse M. Uchino M. Takaso M. Fujita K. Uchiyama T. Okada M. Kasahara M. Itoman Kitasato University Hospital Bone Bank, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan
remain to be resolved in the Japanese orthopaedic field. Keywords Bone graft Retrieval Processing Preservation Donor Advanced medical treatment
Introduction The number of bone grafts performed in the Japanese orthopaedic field is increasing year by year (Iwamoto et al. 1997; Jingushi 2002; Komiya et al. 2003; Sugioka and Masuda 1986; Urabe et al. 2007a). The demand for large bone allografts has also increased. The use of synthetic bone substitutes as a percentage of the total number of bone grafts performed increased; however, the percentage of banked bone allografts remained low because the number of bone banks was insufficient and the bone shipping system from the bone bank to other institutions was not well established (Urabe et al. 2007a, b). One of the reasons for the lack of bone banks and the delayed development of a bone bank network was the underlying financial problem. As the material expense for banked bone allografts was not designated as a covered expense, the bank could not charge for these expenses and instead had to bear the material expenses for retrieval, processing and preservation of banked bone.
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In December 2004, the Japanese government
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