Academic journal article Applied Health Economics and Health Policy

Cost-Effectiveness Analysis of Treatments for Vertebral Compression Fractures

Academic journal article Applied Health Economics and Health Policy

Cost-Effectiveness Analysis of Treatments for Vertebral Compression Fractures

Article excerpt

Key points for decision makers

* Patients in the kyphoplasty group had the longest median life expectancies, followed by vertebroplasty patients, and then by non-operated patients

* Vertebral compression fracture treatments are cost effective in the Medicare population when compared with nonsurgical management, while among patients for whom surgical treatment was indicated, kyphoplasty was found to be cost effective, and perhaps even cost saving, compared with vertebroplasty


Vertebral compression fractures (VCFs) are a significant burden to patients, the healthcare system and society.[1] Osteoporosis is a common cause of a VCF, which can not only be painful, but also serve as a marker for reduced health status and excess mortality.[2] In the US Medicare population, over 200 000 patients are diagnosed with a VCF each year. VCFs can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty. Both VCF treatment procedures involve stabilizing a vertebral fracture by injection of bone cement. Additionally, during kyphoplasty, an inflatable bone tamp is inserted into the vertebral fracture prior to injection of bone cement, to restore the height of the collapsed vertebral body.

Vertebroplasty and balloon kyphoplasty have been in clinical use for over a decade. However, only a fraction of diagnosed VCFs are surgically treated, because the current standard of care is nonsurgical management. In many patients, VCF symptoms subside over time with a combination of bracing, pain medication and rest. In recent years, surgical management of VCFs has become controversial, due largely to inconsistent outcomes reported in the literature for vertebroplasty. In a provocative editorial in the New England Journal of Medicine,[3] pundits advocated that surgical treatment options for VCFs be curtailed as a mechanism to fund comparative effectiveness research, a new Federal government initiative to reduce costs and improve healthcare by objectively comparing the costs, outcomes and cost effectiveness of clinical interventions. Despite the desire to evaluate the comparative effectiveness of vertebroplasty and kyphoplasty, limited data are currently available that compare not only the costs but also the effectiveness of both surgical treatments relative to nonsurgical management.[4]

Using publicly available, longitudinal administrative claims data, our research group has studied outcomes of Medicare beneficiaries who have suffered a VCF.[2,5] It is clear that a VCF diagnosis is a marker for reduced health status and is associated with increased mortality in the Medicare population.[2] In our most recent analysis, which included 858 978 VCF patients in a 4-year sample of the 100% Medicare dataset between 2005 and 2008,[5] we found that patients who received VCF treatment by kyphoplasty or vertebroplasty experienced a significantly reduced adjusted risk of mortality when compared with a non-operated cohort. The implications of reduced mortality risk on the cost effectiveness of VCF treatments for the Medicare population remained unexplored.

The purposes of the present study were to: (i) characterize the cumulative cost from a payer's perspective (specifically Medicare in terms of reimbursements/payments) for treating VCF-diagnosed patients by nonsurgical management, vertebroplasty, or kyphoplasty, and (ii) evaluate the cost effectiveness of these VCF treatments by comparing the cost per life-year gained (LYG). We hypothesized that surgical treatments for VCFs using vertebroplasty or kyphoplasty would be a cost-effective alternative to nonsurgical management for the Medicare patient population. To address this hypothesis, we employed publicly available, longitudinal administrative claims data to study the reimbursements by the Centers for Medicare and Medicaid Services (CMS) for beneficiaries diagnosed with a VCF within a 4-year window. …

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